1 00:00:05,622 --> 00:00:07,657 HELLO AND WELCOME TO DAY ONE 2 00:00:07,657 --> 00:00:09,859 OF OUR WORKSHOP ON CEREBRAL 3 00:00:09,859 --> 00:00:10,059 PALSY. 4 00:00:10,059 --> 00:00:12,295 MY NAME IS THERESA CRUZ I'M THE 5 00:00:12,295 --> 00:00:13,329 DIRECTOR OF THE NATIONAL CENTER 6 00:00:13,329 --> 00:00:16,966 FOR MEDICAL REHABILITATION 7 00:00:16,966 --> 00:00:18,501 RESEARCH AT THE NATIONAL 8 00:00:18,501 --> 00:00:20,069 INSTITUTE OF CHILD HEALTH AND 9 00:00:20,069 --> 00:00:22,872 HUMAN DEVELOPMENT OR NICHD. 10 00:00:22,872 --> 00:00:24,607 AND WE HAVE THE PLEASURE OF 11 00:00:24,607 --> 00:00:26,276 CO-HOSTING THIS WORKSHOP TO 12 00:00:26,276 --> 00:00:28,211 EXAMINE THE PROGRESS AND 13 00:00:28,211 --> 00:00:30,213 CEREBRAL PALSY RESEARCH SINCE 14 00:00:30,213 --> 00:00:31,848 2017 WITH OUR PARTNERS, THE 15 00:00:31,848 --> 00:00:33,449 NATIONAL INSTITUTE OF 16 00:00:33,449 --> 00:00:36,152 NEUROLOGICAL DISORDERS AND 17 00:00:36,152 --> 00:00:36,553 STROKE. 18 00:00:36,553 --> 00:00:36,886 NINDS. 19 00:00:36,886 --> 00:00:38,188 AND YOU WILL BE HEARING MORE 20 00:00:38,188 --> 00:00:39,856 FROM STAFF FROM BOTH INSTITUTES 21 00:00:39,856 --> 00:00:42,458 OVER THE NEXT TWO DAYS. 22 00:00:42,458 --> 00:00:44,460 BEFORE WE BEGIN, I WOULD LIKE TO 23 00:00:44,460 --> 00:00:46,262 ADDRESS A FEW HOUSEKEEPING 24 00:00:46,262 --> 00:00:46,596 ITEMS. 25 00:00:46,596 --> 00:00:49,532 IF I CAN HAVE THE NEXT SLIDE, 26 00:00:49,532 --> 00:00:49,999 THANK YOU. 27 00:00:49,999 --> 00:00:53,069 WE'RE USING A ZOOM WEBINAR AND 28 00:00:53,069 --> 00:00:54,938 THIS IS ALSO SIMULTANEOUS ON THE 29 00:00:54,938 --> 00:00:56,806 NIH VIDEO CAST SYSTEM. 30 00:00:56,806 --> 00:00:59,409 THE MEETING IS BEING RECORDED 31 00:00:59,409 --> 00:01:02,145 AND WILL BE ARCHIVED FOR FUTURE 32 00:01:02,145 --> 00:01:03,213 REFERENCE. 33 00:01:03,213 --> 00:01:04,881 THE AUDIENCE CAN ASK QUESTIONS 34 00:01:04,881 --> 00:01:07,817 AND WE DO ENCOURAGE YOU TO ASK 35 00:01:07,817 --> 00:01:09,686 QUESTIONS AND PARTICIPATE BY 36 00:01:09,686 --> 00:01:13,623 TYPING THEM INTO THE Q&A BOX. 37 00:01:13,623 --> 00:01:15,525 WE HAVE MODERATORS WHO WILL BE 38 00:01:15,525 --> 00:01:16,826 COLLECTING THEM DURING THE 39 00:01:16,826 --> 00:01:18,094 TALKS, AND SO DON'T FEEL LIKE 40 00:01:18,094 --> 00:01:20,430 YOU NEED TO WAIT WHEN THE SPIRIT 41 00:01:20,430 --> 00:01:25,401 MOVES YOU, PLEASE ENTER YOUR 42 00:01:25,401 --> 00:01:26,569 QUESTION AND WE'LL BRING THEM 43 00:01:26,569 --> 00:01:27,870 OUT AT PANEL DISCUSSIONS 44 00:01:27,870 --> 00:01:29,839 SCHEDULED OVER THE NEXT TWO 45 00:01:29,839 --> 00:01:30,039 DAYS. 46 00:01:30,039 --> 00:01:32,008 WE ARE COMBINING LIVE 47 00:01:32,008 --> 00:01:34,844 DISCUSSIONS WITH PRE-RECORDED 48 00:01:34,844 --> 00:01:35,245 TALKS. 49 00:01:35,245 --> 00:01:38,147 SO AGAIN, USING THE Q&A FUNCTION 50 00:01:38,147 --> 00:01:40,750 IS THE BEST WAY TO GET THOSE 51 00:01:40,750 --> 00:01:42,318 TOPICS INTO DISCUSSION. 52 00:01:42,318 --> 00:01:45,088 WE WILL NOT BE PAUSING TO 53 00:01:45,088 --> 00:01:46,756 ADDRESS CLARIFYING QUESTIONS 54 00:01:46,756 --> 00:01:48,558 AFTER EACH TALK. 55 00:01:48,558 --> 00:01:50,326 THERE IS LIVE CAPTIONING ON THE 56 00:01:50,326 --> 00:01:52,362 NIH VIDEO CAST AND SO IF YOU ARE 57 00:01:52,362 --> 00:01:53,763 NOT SEEING THAT IN THE ZOOM, YOU 58 00:01:53,763 --> 00:01:55,765 WOULD DIRECT YOU THERE. 59 00:01:55,765 --> 00:01:58,735 AND USE THE LIVE FEEDBACK LINK 60 00:01:58,735 --> 00:02:01,237 THERE TO PROVIDE YOUR QUESTIONS. 61 00:02:01,237 --> 00:02:04,040 AND IF YOU ARE HAVING 62 00:02:04,040 --> 00:02:08,011 ACCESSIBILITY ISSUES, PLEASE 63 00:02:08,011 --> 00:02:10,613 E-MAIL DAMON CANE HIS E-MAIL ON 64 00:02:10,613 --> 00:02:14,617 THE SLIDE YOU SHOULD SEE NOW. 65 00:02:14,617 --> 00:02:16,386 SO WITH THOSE HOUSEKEEPING 66 00:02:16,386 --> 00:02:19,022 ISSUES OUT OF THE WAY, IT IS MY 67 00:02:19,022 --> 00:02:21,157 PLEASURE TO INTRODUCE OUR FIRST 68 00:02:21,157 --> 00:02:22,258 SET OF TALKS. 69 00:02:22,258 --> 00:02:24,294 FIRST WE WILL HEAR FROM Dr. 70 00:02:24,294 --> 00:02:27,930 DIANA BIANCHI THE DIRECTOR OF 71 00:02:27,930 --> 00:02:30,166 NICHD WHO WILL GIVE YOU A MUCH 72 00:02:30,166 --> 00:02:30,900 MORE POLISHED WELCOME AND SET 73 00:02:30,900 --> 00:02:32,902 THE STAGE FOR THE WORKSHOP. 74 00:02:32,902 --> 00:02:34,437 NEXT YOU WILL BE HEARING FROM ME 75 00:02:34,437 --> 00:02:35,872 AGAIN AND IN A DIFFERENT OUTFIT 76 00:02:35,872 --> 00:02:37,507 AND A HAIRCUT. 77 00:02:37,507 --> 00:02:40,877 AND I'LL BE PRESENTING AN 78 00:02:40,877 --> 00:02:43,479 ANALYSIS OF THE CEREBRAL PALSY 79 00:02:43,479 --> 00:02:44,747 RESEARCH PORTFOLIO AT NIH. 80 00:02:44,747 --> 00:02:46,549 AFTER THAT, WE WILL HEAR A TALK 81 00:02:46,549 --> 00:02:49,185 FROM RACHEL BYRNE, THE EXECUTIVE 82 00:02:49,185 --> 00:02:50,353 DIRECTOR AT THE CEREBRAL PALSY 83 00:02:50,353 --> 00:02:52,021 FOUNDATION AND SHE'S A PHYSICAL 84 00:02:52,021 --> 00:02:53,656 THERAPIST BY TRAINING AND WILL 85 00:02:53,656 --> 00:02:55,892 BE TALKING ABOUT SOME RECENT 86 00:02:55,892 --> 00:02:58,194 ACTIVITIES BY CPF AND THEN I'M 87 00:02:58,194 --> 00:03:01,097 VERY EXCITED TO HEAR FROM 88 00:03:01,097 --> 00:03:02,765 CAYDANCE ANDERSON, A YOUNG WOMAN 89 00:03:02,765 --> 00:03:04,000 WHO WILL PROVIDE THE VOICE OF 90 00:03:04,000 --> 00:03:05,868 THE PARTICIPANT. 91 00:03:05,868 --> 00:03:07,870 IT'S REALLY A PLEASURE TO 92 00:03:07,870 --> 00:03:10,106 KICKOFF THESE MEETINGS WITH THE 93 00:03:10,106 --> 00:03:11,774 PERSPECTIVE OF SOMEONE WHO IS 94 00:03:11,774 --> 00:03:13,476 PARTICIPATING IN RESEARCH 95 00:03:13,476 --> 00:03:15,211 PROTOCOLS AND HOPEFULLY THAT 96 00:03:15,211 --> 00:03:17,480 WILL FRAME THE RESEARCH TALKS 97 00:03:17,480 --> 00:03:19,015 THAT FOLLOW FOR THE REST OF 98 00:03:19,015 --> 00:03:21,951 TODAY AND TOMORROW. 99 00:03:21,951 --> 00:03:23,419 WITHOUT FURTHER DELAY, THANK YOU 100 00:03:23,419 --> 00:03:27,890 AND LET'S GET STARTED. 101 00:03:27,890 --> 00:03:32,028 >> GOOD MORNING. 102 00:03:32,028 --> 00:03:33,930 AND WELCOME TO ALL OF YOU, I'M 103 00:03:33,930 --> 00:03:37,367 Dr. DIANA BIANCHI, DIRECTOR 104 00:03:37,367 --> 00:03:38,768 THE EUNICE KENNEDY SHA ARRIVER 105 00:03:38,768 --> 00:03:40,103 NATIONAL INSTITUTE OF CHILD 106 00:03:40,103 --> 00:03:42,805 HEALTH AND HUMAN DEVELOPMENT 107 00:03:42,805 --> 00:03:43,639 OTHERWISE KNOWN AS NICHD. 108 00:03:43,639 --> 00:03:45,775 IT'S MY PLEASURE TO WELCOME YOU 109 00:03:45,775 --> 00:03:47,443 ALL TO TODAY'S WORKSHOP. 110 00:03:47,443 --> 00:03:51,547 WHICH WAS PLANNED JOINTLY BY THE 111 00:03:51,547 --> 00:03:53,282 STAFF AT NICHD AND THE NATIONAL 112 00:03:53,282 --> 00:03:54,584 INSTITUTE OF NEUROLOGICAL 113 00:03:54,584 --> 00:03:56,386 DISORDERS AND STROKE, OTHERWISE 114 00:03:56,386 --> 00:03:59,155 KNOWN AS NINDS. 115 00:03:59,155 --> 00:04:01,124 THE NIH STRATEGIC PLAN FOR 116 00:04:01,124 --> 00:04:03,192 CEREBRAL PALSY RESEARCH, 117 00:04:03,192 --> 00:04:06,629 RELEASED IN 2017, WAS DESIGNED 118 00:04:06,629 --> 00:04:10,366 AS A TEN-10 PLAN TO GUIDE 119 00:04:10,366 --> 00:04:11,634 CEREBRAL PALSY RESEARCH AREAS. 120 00:04:11,634 --> 00:04:13,302 THESE INCLUDE THE UNDERSTANDING 121 00:04:13,302 --> 00:04:15,405 OF THE UNDERLYING CAUSES AND 122 00:04:15,405 --> 00:04:19,175 PATHO PHYSIOLOGY, IMPROVING 123 00:04:19,175 --> 00:04:21,043 DIAGNOSIS, IDENTIFYING POTENTIAL 124 00:04:21,043 --> 00:04:22,912 PREVENTION STRATEGIES AND 125 00:04:22,912 --> 00:04:24,213 THERAPEUTIC INTERVENTIONS AND 126 00:04:24,213 --> 00:04:28,718 IMPROVING THE QUALITY OF LIFE 127 00:04:28,718 --> 00:04:29,419 FOR PEOPLE WITH CEREBRAL PALSY. 128 00:04:29,419 --> 00:04:31,587 THE GOAL OF TODAY'S WORKSHOP IS 129 00:04:31,587 --> 00:04:34,190 TO EXPLORE PROGRESS MADE IN THE 130 00:04:34,190 --> 00:04:35,591 FIELD OF CEREBRAL PALSY 131 00:04:35,591 --> 00:04:37,226 RESEARCH, SINCE THE PUBLICATION 132 00:04:37,226 --> 00:04:40,029 OF THE NIH STRATEGIC PLAN FOR 133 00:04:40,029 --> 00:04:43,633 CEREBRAL PALSY IN 2017. 134 00:04:43,633 --> 00:04:46,002 THIS 2017 STRATEGIC PLAN WAS 135 00:04:46,002 --> 00:04:48,271 DEVELOPED THROUGH A SERIES OF 136 00:04:48,271 --> 00:04:50,206 WORKSHOPS WITH INPUT FROM THE 137 00:04:50,206 --> 00:04:52,575 ADVOCACY AND PATIENT 138 00:04:52,575 --> 00:04:52,875 COMMUNITIES. 139 00:04:52,875 --> 00:04:54,977 I'M PLEASED TO SEE 140 00:04:54,977 --> 00:04:55,912 REPRESENTATIVES FROM SEVERAL 141 00:04:55,912 --> 00:04:58,614 PATIENT ORGANIZATIONS ATTENDING 142 00:04:58,614 --> 00:05:03,219 TODAY'S MEETING AS WELL AS PAR 143 00:05:03,219 --> 00:05:04,387 PARTICIPATING IN THE AGENDA. 144 00:05:04,387 --> 00:05:06,522 AS THE DIRECTOR OF NICHD, ONE 145 00:05:06,522 --> 00:05:08,758 KEY COMPONENT THAT I'VE ADDED TO 146 00:05:08,758 --> 00:05:11,093 MANY OF OUR SCIENTIFIC MEETINGS, 147 00:05:11,093 --> 00:05:15,498 IS THE RESEARCH, PARTICIPANT PAR 148 00:05:15,498 --> 00:05:16,332 PERSPECTIVE OTHERWISE KNOWN AS 149 00:05:16,332 --> 00:05:18,935 THE VOICE OF THE PARTICIPANT. 150 00:05:18,935 --> 00:05:20,837 OBTAINING INPUT ON BOTH THE 151 00:05:20,837 --> 00:05:23,906 LIVED EXPERIENCES OF PEOPLE WITH 152 00:05:23,906 --> 00:05:24,707 CEREBRAL PALSY, AND AS WELL AS 153 00:05:24,707 --> 00:05:27,443 THEIR PERSONAL EXPERIENCES 154 00:05:27,443 --> 00:05:29,245 PARTICIPATING IN RESEARCH. 155 00:05:29,245 --> 00:05:31,814 OUR VERY INFORMATIVE. 156 00:05:31,814 --> 00:05:33,483 TODAY I'M PARTICULARLY DELIGHTED 157 00:05:33,483 --> 00:05:36,152 TO SEE THAT THE WORKSHOP WILL 158 00:05:36,152 --> 00:05:39,722 BEGIN WITH A CONVERSATION 159 00:05:39,722 --> 00:05:41,057 BETWEEN CAYDANCE ANDERSON, A 160 00:05:41,057 --> 00:05:42,925 YOUNG WOMAN PARTICIPATED IN A 161 00:05:42,925 --> 00:05:44,227 REHABILITATION RESEARCH STUDY 162 00:05:44,227 --> 00:05:47,597 AND RACHEL BYRNE, OF THE 163 00:05:47,597 --> 00:05:49,365 CEREBRAL PALSY FOUNDATION. 164 00:05:49,365 --> 00:05:54,437 AS A MEDICAL GENETICIST WITH A 165 00:05:54,437 --> 00:05:56,772 ACTIVE LAB AT NIH, I'M ALSO 166 00:05:56,772 --> 00:05:57,807 PARTICULARLY INTRIGUED BY THE 167 00:05:57,807 --> 00:06:00,576 RESEARCH FINDINGS THAT THERE ARE 168 00:06:00,576 --> 00:06:02,612 CAUSE TIVE GENOME VARIANTS IN AS 169 00:06:02,612 --> 00:06:07,216 MANY AS A THIRD OF THE PEDIATRIC 170 00:06:07,216 --> 00:06:09,385 CASES OF CEREBRAL PALSY. 171 00:06:09,385 --> 00:06:11,621 NICHD CONTINUES TO SUPPORT THIS 172 00:06:11,621 --> 00:06:13,856 PARADIGM SHIFTING RESEARCH THAT 173 00:06:13,856 --> 00:06:17,660 IS BEING PERFORMED AT THE 174 00:06:17,660 --> 00:06:17,894 CLINIC. 175 00:06:17,894 --> 00:06:19,495 OVER THE NEXT TWO DAYS, WE'RE 176 00:06:19,495 --> 00:06:21,898 GOING TO HEAR FROM NIH 177 00:06:21,898 --> 00:06:24,000 RESEARCHERS AND TRAINEES WHO 178 00:06:24,000 --> 00:06:27,870 WILL HIGHLIGHT ADVANCES IN BASIC 179 00:06:27,870 --> 00:06:31,541 TRANSLATIONAL AND CLINICAL 180 00:06:31,541 --> 00:06:32,108 RESEARCH IN CEREBRAL PALSY. 181 00:06:32,108 --> 00:06:34,844 WE HAVE LEFT PLENTY OF TIME FOR 182 00:06:34,844 --> 00:06:36,245 DISCUSSION FOLLOWING THE 183 00:06:36,245 --> 00:06:38,180 PRESENTATIONS TO TALK ABOUT THE 184 00:06:38,180 --> 00:06:41,517 NEW AND PERSISTENT GAPS AND 185 00:06:41,517 --> 00:06:43,619 OPPORTUNITIES IN THE RESEARCH 186 00:06:43,619 --> 00:06:44,053 PORTFOLIO. 187 00:06:44,053 --> 00:06:46,455 WE HOPE THAT YOU ACTIVELY ENGAGE 188 00:06:46,455 --> 00:06:48,357 THROUGH THE WEBINAR, QUESTION 189 00:06:48,357 --> 00:06:53,229 AND ANSWER FEATURE, TO MAKE THIS 190 00:06:53,229 --> 00:06:56,432 WORKSHOP AS INTERACTIVE AS 191 00:06:56,432 --> 00:06:57,967 POSSIBLE DESPITE THE VIRTUAL 192 00:06:57,967 --> 00:06:58,200 FORMAT. 193 00:06:58,200 --> 00:06:59,602 THIS IS AN IMPORTANT WORKSHOP 194 00:06:59,602 --> 00:07:01,304 THAT WILL ACT AS A CHECK-IN FOR 195 00:07:01,304 --> 00:07:03,105 PROGRESS AT THE HALFWAY POINT OF 196 00:07:03,105 --> 00:07:05,975 THE STRATEGIC PLAN. 197 00:07:05,975 --> 00:07:08,945 THE NEXT TALK IS GOING TO BE BY 198 00:07:08,945 --> 00:07:10,146 Dr. THERESA CRUZ, WHO IS THE 199 00:07:10,146 --> 00:07:12,348 DIRECTOR OF THE NATIONAL CENTER 200 00:07:12,348 --> 00:07:16,385 FOR MEDICAL REHABILITATION 201 00:07:16,385 --> 00:07:17,053 RESEARCH AT NICHD AND SHE'S 202 00:07:17,053 --> 00:07:19,355 GOING TO BRIEFLY REVIEW THE 203 00:07:19,355 --> 00:07:24,160 INVESTMENTS THAT HAVE BEEN MADE 204 00:07:24,160 --> 00:07:25,428 BY NIH IN CEREBRAL PALSY 205 00:07:25,428 --> 00:07:25,895 RESEARCH. 206 00:07:25,895 --> 00:07:27,697 FOLLOWING TODAY'S MEETING, A 207 00:07:27,697 --> 00:07:29,966 SUMMARY WILL BE POSTED TO THE 208 00:07:29,966 --> 00:07:31,734 NIH WEBSITE AND WE HOPE THAT IT 209 00:07:31,734 --> 00:07:33,936 WILL BE USED BY THE RESEARCH 210 00:07:33,936 --> 00:07:37,173 COMMUNITY TO MOVE THE FIELD 211 00:07:37,173 --> 00:07:37,406 FORWARD. 212 00:07:37,406 --> 00:07:39,208 I WOULD LIKE TO CONCLUDE BY 213 00:07:39,208 --> 00:07:41,811 THANKING MY COLLEAGUES AT NINDS 214 00:07:41,811 --> 00:07:43,012 FOR THEIR LEADERSHIP AND 215 00:07:43,012 --> 00:07:46,315 PLANNING THIS WORKSHOP. 216 00:07:46,315 --> 00:07:47,550 THE STAFF AT NICHD, WHOM YOU 217 00:07:47,550 --> 00:07:48,584 WILL BE SEEING AND HEARING FROM 218 00:07:48,584 --> 00:07:51,287 THROUGHOUT THE WORKSHOP, THE 219 00:07:51,287 --> 00:07:52,855 SPEAKERS WHO HAVE SHARED THEIR 220 00:07:52,855 --> 00:07:54,824 TIME AND EXPERTISE, AND OF 221 00:07:54,824 --> 00:07:57,860 COURSE, ALL OF YOU, THE 222 00:07:57,860 --> 00:07:58,227 ATTENDEES. 223 00:07:58,227 --> 00:07:59,895 AS I SAID BEFORE, I REALLY DO 224 00:07:59,895 --> 00:08:02,398 HOPE THAT YOU WILL BE ENGAGE IN 225 00:08:02,398 --> 00:08:05,267 THE CHATBOX VIA THE QUESTION AND 226 00:08:05,267 --> 00:08:06,569 ANSWER FEATURES. 227 00:08:06,569 --> 00:08:09,538 AND CONTRIBUTE TO THE OVER ALL 228 00:08:09,538 --> 00:08:09,839 DISCUSSION. 229 00:08:09,839 --> 00:08:11,207 THANK YOU FOR YOUR INTEREST IN 230 00:08:11,207 --> 00:08:12,775 THIS AREA AND I HOPE THAT YOU 231 00:08:12,775 --> 00:08:16,112 ALL HAVE A VERY PRODUCTIVE 232 00:08:16,112 --> 00:08:19,115 MEETING. 233 00:08:19,115 --> 00:08:19,949 TAKE CARE. 234 00:08:19,949 --> 00:08:21,017 >> GOOD MORNING. 235 00:08:21,017 --> 00:08:23,052 MY NAME IS THERESA CRUZ I'M THE 236 00:08:23,052 --> 00:08:25,087 DIRECTOR THE NATIONAL CENTER FOR 237 00:08:25,087 --> 00:08:28,624 MEDICAL REHABILITATION RESEARCH 238 00:08:28,624 --> 00:08:28,891 AT NICHD. 239 00:08:28,891 --> 00:08:31,761 I WANT TO THANK YOU FOR THE 240 00:08:31,761 --> 00:08:32,728 OPPORTUNITY TO TALK TO YOU TODAY 241 00:08:32,728 --> 00:08:36,632 A LITTLE BIT ABOUT THE NIH 242 00:08:36,632 --> 00:08:38,167 CEREBRAL PALSY RESEARCH 243 00:08:38,167 --> 00:08:38,501 PORTFOLIO. 244 00:08:38,501 --> 00:08:41,570 AND I'M SPEAKING ON BEHALF OF 245 00:08:41,570 --> 00:08:42,271 QUITE A FIE PEOPLE WHO PUT MOST 246 00:08:42,271 --> 00:08:44,940 OF THE WORK INTO THIS SO I WANT 247 00:08:44,940 --> 00:08:47,443 TO THANK RACHEL ANDERSON, CAROLE 248 00:08:47,443 --> 00:08:50,079 LONG, AND THE GROUP AT NINDS. 249 00:08:50,079 --> 00:08:52,548 I WOULD ALSO LIKE TO THANK MY 250 00:08:52,548 --> 00:08:54,417 COLLEAGUES ON THIS WORKSHOP 251 00:08:54,417 --> 00:08:55,618 PLANNING COMMITTEE WHO YOU WILL 252 00:08:55,618 --> 00:08:57,186 BE HEARING FROM THROUGHOUT THE 253 00:08:57,186 --> 00:08:59,655 NEXT TWO DAYS OF THE WORKSHOP. 254 00:08:59,655 --> 00:09:02,024 I'LL ALSO START WITH A QUICK 255 00:09:02,024 --> 00:09:03,092 DISCLAIMER THAT WE'RE GOING TO 256 00:09:03,092 --> 00:09:06,195 BE PRESENTING DATA THAT IS 257 00:09:06,195 --> 00:09:09,231 PUBLICLY AVAILABLE AND THAT WE 258 00:09:09,231 --> 00:09:13,202 HAVE USED THE R CDC CEREBRAL 259 00:09:13,202 --> 00:09:14,503 PALSY CATEGORY FOR MOST OF THIS 260 00:09:14,503 --> 00:09:15,838 PRESENTATION AND WE'VE ALSO 261 00:09:15,838 --> 00:09:18,874 PULLED DATA FROM 262 00:09:18,874 --> 00:09:20,176 CLINICALTRIALS.GOV AND WE'RE 263 00:09:20,176 --> 00:09:21,343 FOCUS ONG THE EXTRAMURAL 264 00:09:21,343 --> 00:09:23,012 RESEARCH FUNDING BECAUSE THAT 265 00:09:23,012 --> 00:09:28,984 WAS THE TARGET AUDIENCE FOR THE 266 00:09:28,984 --> 00:09:29,585 2017 CEREBRAL PALSY STRATEGIC 267 00:09:29,585 --> 00:09:29,852 PLAN. 268 00:09:29,852 --> 00:09:31,353 THIS DATA IS NOT PERFECT SO 269 00:09:31,353 --> 00:09:33,222 THERE ARE A FEW TIMES WHERE I 270 00:09:33,222 --> 00:09:35,591 POINT OUT CAVEATS TO HOPEFULLY 271 00:09:35,591 --> 00:09:37,693 GIVE YOU A MORE ACCURATE AND 272 00:09:37,693 --> 00:09:40,563 COMPLETE PICTURE. 273 00:09:40,563 --> 00:09:43,699 OF THE WORK THAT NIH IS FUNDING 274 00:09:43,699 --> 00:09:44,567 IN CEREBRAL PALSY. 275 00:09:44,567 --> 00:09:47,369 FIRST I'D LIKE TO START OUT BY 276 00:09:47,369 --> 00:09:49,305 SHOWING YOU THE INCREASE IN 277 00:09:49,305 --> 00:09:50,406 FUNDING FOR CEREBRAL PALSY FROM 278 00:09:50,406 --> 00:09:54,710 BEFORE THE TIME OF THE 2017 279 00:09:54,710 --> 00:09:56,512 STRATEGIC PLAN, THROUGH TODAY. 280 00:09:56,512 --> 00:09:58,013 AND YOU CAN SEE THAT THERE ARE 281 00:09:58,013 --> 00:10:02,485 TWO MAJOR FUNDERS OF CEREBRAL 282 00:10:02,485 --> 00:10:04,754 PALSY RESEARCH. 283 00:10:04,754 --> 00:10:05,387 THE NICHD, NATIONAL INSTITUTES 284 00:10:05,387 --> 00:10:08,023 OF CHILD HEALTH AND HUMAN 285 00:10:08,023 --> 00:10:09,692 DEVELOPMENT, AND NINDS, THE 286 00:10:09,692 --> 00:10:10,960 NATIONAL INSTITUTE ON 287 00:10:10,960 --> 00:10:12,361 NEUROLOGICAL DISORDERS AND 288 00:10:12,361 --> 00:10:12,828 STROKE. 289 00:10:12,828 --> 00:10:15,931 BUT THERE ARE ALSO MANY OTHER 290 00:10:15,931 --> 00:10:18,934 INSTITUTES AT NIH THAT SUPPORT 291 00:10:18,934 --> 00:10:20,803 CEREBRAL PALSY RESEARCH AND I'D 292 00:10:20,803 --> 00:10:23,506 LIKE TO ACKNOWLEDGE THEIR 293 00:10:23,506 --> 00:10:23,839 CONTRIBUTIONS. 294 00:10:23,839 --> 00:10:25,808 THERE'S ALSO BEEN A STEADY 295 00:10:25,808 --> 00:10:29,845 INCREASE OF ABOUT $20 MILLION TO 296 00:10:29,845 --> 00:10:33,516 START THIS 10 YEARS AGO TO 297 00:10:33,516 --> 00:10:34,116 AROUND $30 MILLION TODAY. 298 00:10:34,116 --> 00:10:35,551 YOU WILL SEE THAT THERE'S THIS 299 00:10:35,551 --> 00:10:42,458 KIND OF BUM IN 2020 DUE TO A 300 00:10:42,458 --> 00:10:44,026 LARGE COVID SUPPLEMENT OF 301 00:10:44,026 --> 00:10:45,294 $3 MILLION THAT WAS AWARDED TO 302 00:10:45,294 --> 00:10:50,466 OUR MATERNAL FETAL MEDICINE UNIT 303 00:10:50,466 --> 00:10:52,902 COORDINATING COMMITTEE, 304 00:10:52,902 --> 00:10:53,969 COORDINATING CENTER AND THE REST 305 00:10:53,969 --> 00:10:57,106 OF THAT GRANT WAS NOT CODED FOR 306 00:10:57,106 --> 00:10:57,540 CEREBRAL PALSY. 307 00:10:57,540 --> 00:10:59,441 SO, YOU SHOULDN'T THINK OF THIS 308 00:10:59,441 --> 00:11:02,812 AS A DROP FROM 2020 BUT RATHER A 309 00:11:02,812 --> 00:11:09,151 NICE STEADY INCREASE FROM 2013 310 00:11:09,151 --> 00:11:09,585 THROUGH 2021. 311 00:11:09,585 --> 00:11:11,987 THIS IS IN MILLIONS OF DOLLARS 312 00:11:11,987 --> 00:11:13,088 IN CEREBRAL PALSY FUNDING. 313 00:11:13,088 --> 00:11:14,824 THE OTHER THING WE CAN LOOK AT 314 00:11:14,824 --> 00:11:19,628 IS THE NUMBER OF GRANTS THAT ARE 315 00:11:19,628 --> 00:11:20,229 IN CEREBRAL PALSY RESEARCH AS 316 00:11:20,229 --> 00:11:22,665 WELL AS THE TYPES OF RESEARCH 317 00:11:22,665 --> 00:11:25,167 THAT THOSE GRANTS ARE 318 00:11:25,167 --> 00:11:25,501 SUPPORTING. 319 00:11:25,501 --> 00:11:27,403 SO HERE AGAINST WE SEE THIS NICE 320 00:11:27,403 --> 00:11:30,873 TREND OF INCREASING FROM 2013 321 00:11:30,873 --> 00:11:33,609 THROUGH THE TIME OF PLAN WHICH 322 00:11:33,609 --> 00:11:34,810 IS 2018 AND BEYOND. 323 00:11:34,810 --> 00:11:38,380 SO WE'VE GONE FROM AROUND 55 324 00:11:38,380 --> 00:11:42,017 GRANTS TO OVER 70 GRANTS AND IN 325 00:11:42,017 --> 00:11:42,551 CEREBRAL PALSY RESEARCH. 326 00:11:42,551 --> 00:11:45,354 TO ME, WHAT'S PARTICULARLY 327 00:11:45,354 --> 00:11:47,156 ENCOURAGING ABOUT THIS SLIDE IS 328 00:11:47,156 --> 00:11:50,326 THAT WE'VE GONE FROM SIX 329 00:11:50,326 --> 00:11:52,094 CLINICAL TRIALS TO 18 CLINICAL 330 00:11:52,094 --> 00:11:53,028 TRIALS. 331 00:11:53,028 --> 00:11:55,197 SO, THIS IS A THREE-FOLD 332 00:11:55,197 --> 00:11:57,566 INCREASE IN THE A LOT OF 333 00:11:57,566 --> 00:12:01,170 INTERVENTIONAL RESEARCH FOR 334 00:12:01,170 --> 00:12:01,737 PEOPLE WITH CEREBRAL PALSY. 335 00:12:01,737 --> 00:12:03,906 SOME OF THAT IS GOING TO BE AN 336 00:12:03,906 --> 00:12:05,374 ARTIFACT OF CHANGING 337 00:12:05,374 --> 00:12:08,911 DEFINITIONS, BUT I DO THINK THAT 338 00:12:08,911 --> 00:12:10,946 THE TREND TOWARDS MORE TREATMENT 339 00:12:10,946 --> 00:12:13,215 OPTIONS IS WHAT WE'RE SEEING IN 340 00:12:13,215 --> 00:12:13,883 THIS DATA. 341 00:12:13,883 --> 00:12:18,754 SO THAT IS OUR 20,000-FOOT VIEW 342 00:12:18,754 --> 00:12:21,123 OF THE CEREBRAL PALSY RESEARCH 343 00:12:21,123 --> 00:12:21,924 PORTFOLIO. 344 00:12:21,924 --> 00:12:23,759 NOW, DIGGING MORE INTO THE 345 00:12:23,759 --> 00:12:24,827 STRATEGIC PLAN THAT WAS 346 00:12:24,827 --> 00:12:27,663 PUBLISHED IN 2017, THERE WERE 347 00:12:27,663 --> 00:12:29,598 THREE PRIORITY AREAS 348 00:12:29,598 --> 00:12:30,132 HIGHLIGHTED. 349 00:12:30,132 --> 00:12:31,133 THE FIRST BASIC AND 350 00:12:31,133 --> 00:12:33,068 TRANSLATIONAL RESEARCH AND IT 351 00:12:33,068 --> 00:12:35,571 HAS HAD FOUR OBJECTIVES 352 00:12:35,571 --> 00:12:36,906 UNDERNEATH IT, I'M NOT GOING TO 353 00:12:36,906 --> 00:12:37,840 READ THEM ALL HERE. 354 00:12:37,840 --> 00:12:39,108 YOU CAN SEE THEM AND YOU HAVE 355 00:12:39,108 --> 00:12:41,277 ACCESS TO THAT PLAN. 356 00:12:41,277 --> 00:12:45,114 THE SECOND RESEARCH PRIORITY WAS 357 00:12:45,114 --> 00:12:47,082 CLINICAL RESEARCH AND WE HAD 358 00:12:47,082 --> 00:12:49,351 FIVE OBJECTS UNDERNEATH IT AND 359 00:12:49,351 --> 00:12:51,053 THE THIRD PRIORITY AREA IS 360 00:12:51,053 --> 00:12:53,289 WORKFORCE DEVELOPMENT. 361 00:12:53,289 --> 00:12:55,891 NOW, RATHER THAN TAKE ALL OF 362 00:12:55,891 --> 00:12:57,559 THOSE 70 GRANTS AND PUT THEM 363 00:12:57,559 --> 00:13:01,263 INTO EACH OF THESE OBJECTIVES 364 00:13:01,263 --> 00:13:03,365 AND PRIORITY AREAS, THAT PROVED 365 00:13:03,365 --> 00:13:04,233 REALLY DIFFICULT BECAUSE THERE 366 00:13:04,233 --> 00:13:07,403 WAS A LOT OF OVERLAP IN THESE 367 00:13:07,403 --> 00:13:07,970 TOPICS. 368 00:13:07,970 --> 00:13:09,505 SO WHAT WE'VE INSTEAD DECIDED TO 369 00:13:09,505 --> 00:13:13,309 DO IS TO SHOW YOU EXAMPLES OF 370 00:13:13,309 --> 00:13:16,812 FOR THE MOST PORT, RO1 371 00:13:16,812 --> 00:13:18,647 APPLICATION AWARDS THAT ARE 372 00:13:18,647 --> 00:13:21,483 BEING FUNDED UNDER EACH OF THESE 373 00:13:21,483 --> 00:13:22,451 OBJECTIVES. 374 00:13:22,451 --> 00:13:25,321 SO, FIRST, IN PRIORITY AREA 1, 375 00:13:25,321 --> 00:13:27,756 WE HAVE EXAMPLES OF BASIC AND 376 00:13:27,756 --> 00:13:30,092 TRANSLATIONAL RESEARCH. 377 00:13:30,092 --> 00:13:30,926 AGAIN, I'M NOT GOING TO READ ALL 378 00:13:30,926 --> 00:13:33,963 THE TITLES, BUT YOU CAN SEE WE 379 00:13:33,963 --> 00:13:35,998 ARE COVERING MECHANISMS, BOTH 380 00:13:35,998 --> 00:13:38,934 THROUGH ANIMAL MODELS AND IN 381 00:13:38,934 --> 00:13:41,036 HUMAN RESEARCH. 382 00:13:41,036 --> 00:13:47,076 NEW TECHNIQUES IN NEUROIMAGING, 383 00:13:47,076 --> 00:13:50,879 BIOMARKERS, AND AS WELL AS NEURO 384 00:13:50,879 --> 00:13:54,817 PLASTICITY BOTH IN PEOPLE AT 385 00:13:54,817 --> 00:13:56,585 RISK FOR CEREBRAL PALSY AND WITH 386 00:13:56,585 --> 00:14:04,193 CEREBRAL PALSY DIAGNOSIS, OUR 387 00:14:04,193 --> 00:14:05,627 SECOND IS CLINICAL RESEARCH. 388 00:14:05,627 --> 00:14:08,230 SO WEST OBJECTIVES OF LIVES SPAN 389 00:14:08,230 --> 00:14:10,332 APPROACH, NEW TREATMENTS, 390 00:14:10,332 --> 00:14:13,068 ALTERNATIVE STUDY DESIGNS, AND 391 00:14:13,068 --> 00:14:15,270 MORE RESEARCH INTO METRICS AND 392 00:14:15,270 --> 00:14:17,272 THE USE OF DATA SHARING. 393 00:14:17,272 --> 00:14:19,908 AGAIN, I'M NOT GOING TO READ ALL 394 00:14:19,908 --> 00:14:22,711 THESE TITLES, BUT WE DID WANT TO 395 00:14:22,711 --> 00:14:25,080 SHOW THAT WE HAVE WORK IN 396 00:14:25,080 --> 00:14:26,982 DIAGNOSTICS AND PREVENTION AND 397 00:14:26,982 --> 00:14:29,018 EARLY INTERVENTION, AND 398 00:14:29,018 --> 00:14:31,620 TREATMENT OF OLDER TEENS. 399 00:14:31,620 --> 00:14:34,123 WE DID NOTICE THAT THERE IS A 400 00:14:34,123 --> 00:14:36,759 LACK OF APPLICATIONS AND AWARDS 401 00:14:36,759 --> 00:14:39,795 IN TREATMENT FOR ADULTS WITH 402 00:14:39,795 --> 00:14:40,195 CEREBRAL PALSY. 403 00:14:40,195 --> 00:14:41,830 SO WE'RE NOT ADDRESSING THE 404 00:14:41,830 --> 00:14:42,698 ENTIRE LIFESPAN. 405 00:14:42,698 --> 00:14:44,099 WE'LL TALK MORE ABOUT THAT 406 00:14:44,099 --> 00:14:44,566 LATER. 407 00:14:44,566 --> 00:14:47,169 BUT THAT CONTINUES TO BE A GAP 408 00:14:47,169 --> 00:14:49,638 IN AN OPPORTUNITY FOR THE 409 00:14:49,638 --> 00:14:50,339 RESEARCH FIELD. 410 00:14:50,339 --> 00:14:52,674 WE ARE CERTAINLY INVESTIGATING 411 00:14:52,674 --> 00:14:54,343 TREATMENTS AND THAT HAS COME UP 412 00:14:54,343 --> 00:14:57,880 IN THE INCREASE IN THE NUMBER OF 413 00:14:57,880 --> 00:14:58,480 CLINICAL TRIALS. 414 00:14:58,480 --> 00:15:01,750 BECAUSE OF THE DEVELOPMENTAL 415 00:15:01,750 --> 00:15:04,987 ASPECT OF CEREBRAL PALSY, WE 416 00:15:04,987 --> 00:15:06,886 HAVE SEVERAL PROJECTS NOT DOING 417 00:15:06,886 --> 00:15:07,874 THE TRADITIONAL RANDOMIZED 418 00:15:07,874 --> 00:15:09,889 CONTROL TRIAL BUT ARE 419 00:15:09,889 --> 00:15:12,591 USING OTHER STUDY DESIGNS AND 420 00:15:12,591 --> 00:15:14,927 WE'VE ALSO NOTED THAT IT'S QUITE 421 00:15:14,927 --> 00:15:21,267 IMPORTANT TO MAKE SURE THAT OUR 422 00:15:21,267 --> 00:15:22,468 PROPERTIES OF SCALES ARE 423 00:15:22,468 --> 00:15:24,136 ASSESSED AND VALIDATED FOR 424 00:15:24,136 --> 00:15:26,472 PEOPLE WITH CEREBRAL PALSY. 425 00:15:26,472 --> 00:15:28,374 DIGGING A LITTLE BIT FURTHER 426 00:15:28,374 --> 00:15:30,509 HERE, WE WANTED TO HIGHLIGHT A 427 00:15:30,509 --> 00:15:35,714 REQUEST FOR APPLICATIONS FOR 428 00:15:35,714 --> 00:15:38,417 RO1s AND AT NICHD PUBLISHED IN 429 00:15:38,417 --> 00:15:39,151 2020. 430 00:15:39,151 --> 00:15:42,221 WE FUNDED THREE AWARDS. 431 00:15:42,221 --> 00:15:44,457 ALL OF WHICH WERE IN CEREBRAL 432 00:15:44,457 --> 00:15:45,324 PALSY RESEARCH. 433 00:15:45,324 --> 00:15:47,660 I THINK THIS REALLY SPEAKS TO 434 00:15:47,660 --> 00:15:50,029 THE STRENGTH OF THE CEREBRAL 435 00:15:50,029 --> 00:15:52,398 PALSY RESEARCH COMMUNITY. 436 00:15:52,398 --> 00:15:54,233 WE DID NOT PARTICULARLY 437 00:15:54,233 --> 00:15:56,769 HIGHLIGHT OR SEEK TO ONLY GET 438 00:15:56,769 --> 00:15:59,605 TOP-SCORING APPLICATIONS IN THIS 439 00:15:59,605 --> 00:16:00,873 AREA, BUT THEY REALLY ROSE TO 440 00:16:00,873 --> 00:16:01,740 THE TOP. 441 00:16:01,740 --> 00:16:04,777 SO I THINK THIS BODES VERY WELL 442 00:16:04,777 --> 00:16:07,046 FOR THE FUTURE OF CEREBRAL PALSY 443 00:16:07,046 --> 00:16:07,313 RESEARCH. 444 00:16:07,313 --> 00:16:09,048 AND THOSE AWARDS ARE HIGHLIGHTED 445 00:16:09,048 --> 00:16:12,418 IN RED HERE. 446 00:16:12,418 --> 00:16:16,088 WE TALKED ABOUT CLINICAL TRIALS 447 00:16:16,088 --> 00:16:18,991 AND WE ARE SUPPORTING SEVERAL, 448 00:16:18,991 --> 00:16:21,727 QUITE LARGE, CLINICAL TRIALS. 449 00:16:21,727 --> 00:16:24,697 ONE OF THE STRUGGLES THAT THE 450 00:16:24,697 --> 00:16:30,102 COMMUNITY HAS IS THE HETERO GENE 451 00:16:30,102 --> 00:16:31,871 TEE OF THE CEREBRAL PALSY 452 00:16:31,871 --> 00:16:33,439 DIAGNOSIS AND TREATMENT IN 453 00:16:33,439 --> 00:16:33,739 RECRUITMENT. 454 00:16:33,739 --> 00:16:36,342 WE WANTED TO HIGHLIGHT THAT IN 455 00:16:36,342 --> 00:16:37,376 SEVERAL STUDIES. 456 00:16:37,376 --> 00:16:40,946 WE ARE AIMING TO RECRUIT LARGE 457 00:16:40,946 --> 00:16:51,490 NUMBERS OF PARTICIPANTS WE HAVE 458 00:16:57,796 --> 00:17:01,433 A RESEARCH CONSORTIUM WAS NOT 459 00:17:01,433 --> 00:17:02,601 PICKED UP IN OUR CEREBRAL PALSY 460 00:17:02,601 --> 00:17:05,070 R CDC CATEGORY BUT WE DID THINK 461 00:17:05,070 --> 00:17:07,273 IT WAS IMPORTANT TO HIGHLIGHT IT 462 00:17:07,273 --> 00:17:10,042 IN THIS MEETING BECAUSE IT IS A 463 00:17:10,042 --> 00:17:12,778 MAJOR EFFORT THAT WE ARE 464 00:17:12,778 --> 00:17:13,646 UNDERTAKING AND YOU WILL HEAR 465 00:17:13,646 --> 00:17:14,914 MORE ABOUT THAT TRIAL LATER ON 466 00:17:14,914 --> 00:17:18,684 IN THE CONFERENCE. 467 00:17:18,684 --> 00:17:20,686 SO, WE WANTED TO DIG A LITTLE 468 00:17:20,686 --> 00:17:22,121 BIT MORE INTO THIS CLINICAL 469 00:17:22,121 --> 00:17:24,156 TRIALS DATA BECAUSE WE KNOW THAT 470 00:17:24,156 --> 00:17:28,027 IT'S IMPORTANT TO THE 471 00:17:28,027 --> 00:17:28,494 STAKEHOLDER COMMUNITY. 472 00:17:28,494 --> 00:17:31,564 SO WE RAN THOSE NIH-FINANCED 473 00:17:31,564 --> 00:17:34,833 AWARDS THROUGH 474 00:17:34,833 --> 00:17:35,901 CLINICALTRIALS.GOV TO SEE HOW 475 00:17:35,901 --> 00:17:36,835 THEY ARE RECRUITING AND 476 00:17:36,835 --> 00:17:38,938 REPORTING OUT TO THE COMMUNITY. 477 00:17:38,938 --> 00:17:41,006 AND YOU WILL SEE THAT MOST OF 478 00:17:41,006 --> 00:17:43,576 THE TRIALS THAT WE ARE 479 00:17:43,576 --> 00:17:46,812 SUPPORTING, HAVE IDENTIFIED 480 00:17:46,812 --> 00:17:49,348 CEREBRAL PALSY AS A DIAGNOSTIC 481 00:17:49,348 --> 00:17:53,185 CATEGORY AND THEY ARE PROVIDING 482 00:17:53,185 --> 00:17:53,519 INTERVENTIONS. 483 00:17:53,519 --> 00:17:54,720 SO THAT'S 21 HERE. 484 00:17:54,720 --> 00:17:56,589 BUT AGAIN, THERE ARE OTHER 485 00:17:56,589 --> 00:17:59,058 TOPICS RELATED TO CEREBRAL PALSY 486 00:17:59,058 --> 00:18:02,494 OR THAT MAY BE RISK FACTORS FOR 487 00:18:02,494 --> 00:18:05,264 C.P. THAT WERE ALSO PART OF OUR 488 00:18:05,264 --> 00:18:06,231 CATCHMENT AND THEN THERE ARE 489 00:18:06,231 --> 00:18:09,501 SOME STUDIES THAT ARE 490 00:18:09,501 --> 00:18:10,803 OBSERVATIONAL AND NOT TARGETED 491 00:18:10,803 --> 00:18:13,439 TO PROVIDE THERAPY. 492 00:18:13,439 --> 00:18:15,774 THE OTHER THING WE DID IS DIG A 493 00:18:15,774 --> 00:18:18,777 BIT DEEPER INTO THE AGES OF THE 494 00:18:18,777 --> 00:18:20,713 SUBJECTS THAT ARE BEING 495 00:18:20,713 --> 00:18:22,247 RECRUITED AND TO THOSE TRIALS. 496 00:18:22,247 --> 00:18:23,749 AGAIN, BECAUSE WE KNOW LIFESPAN 497 00:18:23,749 --> 00:18:25,517 IS SUCH AN IMPORTANT ISSUE HERE. 498 00:18:25,517 --> 00:18:29,655 WE SAW THAT THE MAJORITY OF OUR 499 00:18:29,655 --> 00:18:36,428 TRIALS ARE TARGETED TOWARDS 500 00:18:36,428 --> 00:18:38,564 CHILDREN AND INFANTS. 501 00:18:38,564 --> 00:18:42,468 WE DID HAVE A SMALL AMOUNT, 502 00:18:42,468 --> 00:18:44,403 INCLUDING ADULTS, AGES 18 AND 503 00:18:44,403 --> 00:18:44,870 UP. 504 00:18:44,870 --> 00:18:47,039 SO AGAIN, THIS IS AN AREA WHERE 505 00:18:47,039 --> 00:18:49,875 WE COULD BE DOING BETTER AS FAR 506 00:18:49,875 --> 00:18:52,244 AS THE ADULT AND AGING OF 507 00:18:52,244 --> 00:18:53,145 CEREBRAL PALSY. 508 00:18:53,145 --> 00:18:56,015 THIS IS MY FAVORITE SLIDE. 509 00:18:56,015 --> 00:18:59,451 SO THE THIRD PRIORITY AREA IS 510 00:18:59,451 --> 00:19:00,119 DEVELOPMENT OF THE CEREBRAL 511 00:19:00,119 --> 00:19:01,687 PALSY RESEARCH WORKFORCE. 512 00:19:01,687 --> 00:19:05,958 SO HERE I THINK WE SHOW AN 513 00:19:05,958 --> 00:19:07,760 INCREDIBLE GROWTH IN THE NUMBER 514 00:19:07,760 --> 00:19:09,895 OF FELLOWSHIP AWARDS AND 515 00:19:09,895 --> 00:19:12,564 TRAINING AND CAREER DEVELOPMENT 516 00:19:12,564 --> 00:19:15,267 FROM BEFORE THE STRATEGIC PLAN 517 00:19:15,267 --> 00:19:15,601 UNTIL AFTER. 518 00:19:15,601 --> 00:19:19,905 SO WE SEE THAT WE HAVE DOUBLED 519 00:19:19,905 --> 00:19:22,474 THE NUMBER OF FELLOWSHIPS. 520 00:19:22,474 --> 00:19:25,177 WE SEE INCREASES IN THE MENTORED 521 00:19:25,177 --> 00:19:30,482 EARLY KA RO CAREER DEVELOPMENT L 522 00:19:30,482 --> 00:19:34,620 AS THE NCMRR EARLY CAREER RO3s 523 00:19:34,620 --> 00:19:36,422 AND WE'VE SUPPORTED DIVERSITY 524 00:19:36,422 --> 00:19:40,492 SUPPLEMENT THIS IS THE AREA OF 525 00:19:40,492 --> 00:19:41,460 CEREBRAL PALSY. 526 00:19:41,460 --> 00:19:43,095 I THINK IT'S REALLY WONDERFUL 527 00:19:43,095 --> 00:19:44,596 AND IT SHOWS WE'RE DEVELOPING A 528 00:19:44,596 --> 00:19:48,333 PIPELINE OF RESEARCHER IN 529 00:19:48,333 --> 00:19:50,035 CEREBRAL PALSY RESEARCH AND THAT 530 00:19:50,035 --> 00:19:51,737 THEY WILL HOPEFULLY BE PUTTING 531 00:19:51,737 --> 00:19:54,173 IN RO1s IN THE NEXT FIVE TO 10 532 00:19:54,173 --> 00:19:54,373 YEARS. 533 00:19:54,373 --> 00:19:56,542 THEY WILL BE CREATING AND 534 00:19:56,542 --> 00:19:58,577 STARTING THEIR OWN LABS AND 535 00:19:58,577 --> 00:20:01,180 RESEARCH CAREERS. 536 00:20:01,180 --> 00:20:02,848 AS FAR AS THE AMOUNT OF MONEY 537 00:20:02,848 --> 00:20:05,484 THAT GOES TO THESE TRAINING AND 538 00:20:05,484 --> 00:20:07,286 KA ROAR DEVELOPMENT AWARDS, WE 539 00:20:07,286 --> 00:20:12,391 HAVE INCREASED FROM 4.7% TO 6.5% 540 00:20:12,391 --> 00:20:14,960 SO WE ARE PUTTING MORE MONEY 541 00:20:14,960 --> 00:20:22,434 INTO THESE AWARDS AND WE'VE SEEN 542 00:20:22,434 --> 00:20:24,203 20% OF THE FRIENDS IN CP ARE IN 543 00:20:24,203 --> 00:20:26,205 THE FIELD OF TRAINING OR CAREER 544 00:20:26,205 --> 00:20:26,905 DEVELOPMENT. 545 00:20:26,905 --> 00:20:28,540 AGAIN, THIS GIVES ME GREAT 546 00:20:28,540 --> 00:20:31,877 PLEASURE TO REPORT AND REALLY 547 00:20:31,877 --> 00:20:33,278 HOPEFUL FOR THE DIRECTION WE 548 00:20:33,278 --> 00:20:35,981 WANT TO GO IN GROWING THIS 549 00:20:35,981 --> 00:20:36,248 FIELD. 550 00:20:36,248 --> 00:20:38,617 WE WANTED TO HIGHLIGHT THERE ARE 551 00:20:38,617 --> 00:20:41,386 MANY OTHER ACTIVITIES THAT 552 00:20:41,386 --> 00:20:43,388 DIDN'T FIT QUITE INTO THE 553 00:20:43,388 --> 00:20:45,657 CATEGORY OF GRANT FUNDING BUT 554 00:20:45,657 --> 00:20:48,460 WERE RELATED TO THE PRIORITIES 555 00:20:48,460 --> 00:20:50,162 OF THE STRATEGIC PLAN. 556 00:20:50,162 --> 00:20:52,431 SO WE WANTED TO HIGHLIGHT THE 557 00:20:52,431 --> 00:20:53,766 TOOL KITS PRODUCED BY THE 558 00:20:53,766 --> 00:20:58,270 CEREBRAL PALSY RESEARCH NETWORK 559 00:20:58,270 --> 00:21:00,172 AND AND HIGHLIGHT THE 560 00:21:00,172 --> 00:21:02,341 COLLABORATION BETWEEN NINDS AND 561 00:21:02,341 --> 00:21:07,045 NICHD WITH THE OFFICE OF DISEASE 562 00:21:07,045 --> 00:21:08,080 PREVENTION AND LOOKING AT 563 00:21:08,080 --> 00:21:09,381 PHYSICAL ACTIVITY AND THE HEALTH 564 00:21:09,381 --> 00:21:12,017 OF WHEELCHAIR USERS AND CEREBRAL 565 00:21:12,017 --> 00:21:14,653 PALSY WAS ONE OF THREE 566 00:21:14,653 --> 00:21:17,790 DIAGNOSTIC CATEGORIES THAT WERE 567 00:21:17,790 --> 00:21:19,458 FEATURED IN THE SYSTEMATIC 568 00:21:19,458 --> 00:21:21,927 REVIEW AND IN THE WORKSHOP. 569 00:21:21,927 --> 00:21:26,365 WE'RE QUITE PROUD OF THAT. 570 00:21:26,365 --> 00:21:28,734 NINDS HAS BEEN DOING INCREDIBLE 571 00:21:28,734 --> 00:21:32,437 WORK IN PUBLISHING COMMON DATA 572 00:21:32,437 --> 00:21:33,172 ELEMENTS. 573 00:21:33,172 --> 00:21:36,108 THERE'S A SET FOR CEREBRAL PALSY 574 00:21:36,108 --> 00:21:38,043 THAT IS REGULARLY UPDATED AND 575 00:21:38,043 --> 00:21:40,345 YOU WILL BE HEARING MORE FROM 576 00:21:40,345 --> 00:21:43,048 THAT WORKING GROUP LATER ON IN 577 00:21:43,048 --> 00:21:45,384 THE WORKSHOP. 578 00:21:45,384 --> 00:21:47,886 SO, AS A PART OF OUR CONTINUED 579 00:21:47,886 --> 00:21:49,788 COMMITMENT, TO GET FEEDBACK FROM 580 00:21:49,788 --> 00:21:53,592 THE RESEARCH COMMUNITY, PRIOR TO 581 00:21:53,592 --> 00:21:56,795 THE AGENDA SETTING FOR THIS 582 00:21:56,795 --> 00:21:59,131 WORKSHOP, WE PUBLISHED A REQUEST 583 00:21:59,131 --> 00:21:59,965 FOR INFORMATION. 584 00:21:59,965 --> 00:22:02,134 WE WERE ASKING FOR RECENT 585 00:22:02,134 --> 00:22:03,936 ADVANCES, CHALLENGES AND 586 00:22:03,936 --> 00:22:06,104 OPPORTUNITIES IN ANY AREA OF 587 00:22:06,104 --> 00:22:07,339 CEREBRAL PALSY RESEARCH BUT 588 00:22:07,339 --> 00:22:08,607 PARTICULARLY THOSE OUTLINED IN 589 00:22:08,607 --> 00:22:10,709 OUR STRATEGIC PLAN. 590 00:22:10,709 --> 00:22:12,244 WE RECEIVED 25 RESPONSES WHICH 591 00:22:12,244 --> 00:22:13,545 IS INCREDIBLE BECAUSE THIS IS 592 00:22:13,545 --> 00:22:15,914 ONLY OUT ON THE STREET FOR A FEW 593 00:22:15,914 --> 00:22:16,215 WEEKS. 594 00:22:16,215 --> 00:22:18,851 AND WE HEARD FROM PEOPLE WITH 595 00:22:18,851 --> 00:22:21,553 CEREBRAL PALSY, THEIR FAMILY 596 00:22:21,553 --> 00:22:22,721 MEMBERS, PERMISSION TO TREAT 597 00:22:22,721 --> 00:22:24,623 PEOPLE WITH CP, ACADEMIC 598 00:22:24,623 --> 00:22:27,092 DEPARTMENTS IN RESEARCH 599 00:22:27,092 --> 00:22:28,493 INSTITUTIONS, ORGANIZATIONS WHO 600 00:22:28,493 --> 00:22:30,028 ADVOCATE FOR PEOPLE WITH CP AND 601 00:22:30,028 --> 00:22:32,364 THEN ORGANIZATIONS WHO CARE FOR 602 00:22:32,364 --> 00:22:33,131 PEOPLE WITH CP. 603 00:22:33,131 --> 00:22:35,100 I WANT TO THANK ALL THE 604 00:22:35,100 --> 00:22:37,035 RESPONDENTS FOR TAKING THE TIME 605 00:22:37,035 --> 00:22:40,205 TO PROVIDE US WITH THAT INPUT. 606 00:22:40,205 --> 00:22:42,808 SO SOME OF THE COMMON THEMES WE 607 00:22:42,808 --> 00:22:44,309 HEARD OR ONE THAT WE NEED TO 608 00:22:44,309 --> 00:22:45,744 LOOK AT THE LIFESPAN, 609 00:22:45,744 --> 00:22:47,779 PARTICULARLY AGING WITH CEREBRAL 610 00:22:47,779 --> 00:22:48,247 PALSY. 611 00:22:48,247 --> 00:22:49,948 AND THE HEALTH NEEDS OF 612 00:22:49,948 --> 00:22:50,916 ADULTHOOD CEREBRAL PALSY. 613 00:22:50,916 --> 00:22:52,084 AND WE HAVE IDENTIFIED THAT THAT 614 00:22:52,084 --> 00:22:56,021 CONTINUES TO BE A GAP IN OUR 615 00:22:56,021 --> 00:22:56,388 PORTFOLIO. 616 00:22:56,388 --> 00:22:58,290 WE ALSO NEED TO DO MORE 617 00:22:58,290 --> 00:23:00,259 IMPLEMENTATION RESEARCH SO AS WE 618 00:23:00,259 --> 00:23:03,128 CONDUCT CLINICAL TRIALS AND WE 619 00:23:03,128 --> 00:23:05,030 FIND EFFECTIVE TREATMENTS, HOW 620 00:23:05,030 --> 00:23:07,032 THEY ARE IMPLEMENTED IN CLINICAL 621 00:23:07,032 --> 00:23:09,635 CARE AND HOW THEY ARE 622 00:23:09,635 --> 00:23:10,335 OPERATIONALIZED TO SOMETHING 623 00:23:10,335 --> 00:23:14,740 THAT ALSO NEEDS TO BE A 624 00:23:14,740 --> 00:23:15,774 PRIORITY. 625 00:23:15,774 --> 00:23:17,676 ONE THING THAT WAS LACKING IN 626 00:23:17,676 --> 00:23:19,811 THE ORIGINAL STRATEGIC PLAN WAS 627 00:23:19,811 --> 00:23:22,247 A FOCUS ON HEALTH DISPARITIES 628 00:23:22,247 --> 00:23:25,684 AND INCLUSION IN CEREBRAL PALSY 629 00:23:25,684 --> 00:23:26,084 RESEARCH. 630 00:23:26,084 --> 00:23:27,352 SO WE DEFINITELY NEED TO DO MORE 631 00:23:27,352 --> 00:23:29,688 IN LOOKING AT HEALTH DISPARITIES 632 00:23:29,688 --> 00:23:31,957 WITH RESPECT TO SERVICES. 633 00:23:31,957 --> 00:23:35,327 WITH RESPECT TO GENETIC 634 00:23:35,327 --> 00:23:37,195 DATABASES, WE'RE SEEING MORE AND 635 00:23:37,195 --> 00:23:39,598 MORE WORK IN GENOMICS RELATED TO 636 00:23:39,598 --> 00:23:40,132 CEREBRAL PALSY. 637 00:23:40,132 --> 00:23:42,868 AND IF WE DON'T HAVE DIVERSE 638 00:23:42,868 --> 00:23:44,036 DATASETS, WE'RE NOT GOING TO BE 639 00:23:44,036 --> 00:23:47,739 ABLE TO MAKE THE MOST OF THAT 640 00:23:47,739 --> 00:23:48,073 INFORMATION. 641 00:23:48,073 --> 00:23:50,809 AND THEN HOW DO WE REDUCE 642 00:23:50,809 --> 00:23:54,646 BARRIERS TO PARTICIPATION 643 00:23:54,646 --> 00:23:59,685 RESEARCH? 644 00:23:59,685 --> 00:24:01,286 WE WERE ENCOURAGED TO REPAIN 645 00:24:01,286 --> 00:24:04,489 WITH THE PATIENT AT OUTCOME. 646 00:24:04,489 --> 00:24:06,792 WE'RE EXCITED TO HAVE A RESEARCH 647 00:24:06,792 --> 00:24:10,996 PARTICIPANT LATER ON IN THE 648 00:24:10,996 --> 00:24:11,296 CONFERENCE. 649 00:24:11,296 --> 00:24:14,800 THERE WAS A LARGE EMPHASIS ON 650 00:24:14,800 --> 00:24:15,867 CONDITIONS ASSOCIATED WITH 651 00:24:15,867 --> 00:24:18,837 CEREBRAL PALSY OR SECONDARY TO 652 00:24:18,837 --> 00:24:20,839 CEREBRAL PALSY THAT ALSO EFFECT 653 00:24:20,839 --> 00:24:24,209 HEALTH OUTCOMES SO VISUAL 654 00:24:24,209 --> 00:24:25,978 IMPAIRMENTS, PAIN, CHANGES IN 655 00:24:25,978 --> 00:24:27,913 COGNITION, BONE HEALTH, 656 00:24:27,913 --> 00:24:28,847 CARDIOVASCULAR HEALTH, SOCIAL 657 00:24:28,847 --> 00:24:30,248 AND EMOTIONAL HEALTH SO ASIDE 658 00:24:30,248 --> 00:24:33,051 FROM THE MOTOR IMPAIRMENTS OF 659 00:24:33,051 --> 00:24:36,254 CP, TAKING CARE OF THE WHOLE 660 00:24:36,254 --> 00:24:38,890 PERSON AND FINALLY SUPPORT FOR 661 00:24:38,890 --> 00:24:45,230 THE CEREBRAL PALSY RESEARCH 662 00:24:45,230 --> 00:24:45,564 WORKFORCE. 663 00:24:45,564 --> 00:24:46,698 WITH THAT I WILL SAY THANK YOU. 664 00:24:46,698 --> 00:24:48,433 I WILL TAKE QUESTIONS FOR THE 665 00:24:48,433 --> 00:24:52,771 Q&A CHAT AND I WILL BE AVAILABLE 666 00:24:52,771 --> 00:24:54,473 DURING THE FIRST BREAK WHEN WE 667 00:24:54,473 --> 00:24:55,474 HAVE OUR DISCUSSION PERIOD. 668 00:24:55,474 --> 00:24:59,177 THANK YOU SO MUCH. 669 00:24:59,177 --> 00:25:00,946 >> HI, THANK YOU TO MUCH, I'M 670 00:25:00,946 --> 00:25:02,414 RACHEL BYRNE OF THE CEREBRAL 671 00:25:02,414 --> 00:25:04,416 PALSY FOUNDATION EXECUTIVE 672 00:25:04,416 --> 00:25:04,850 DIRECTOR. 673 00:25:04,850 --> 00:25:06,318 MY BACKGROUND IS A PHYSICAL 674 00:25:06,318 --> 00:25:09,154 THERAPIST, RESEARCHER AND HEARD. 675 00:25:09,154 --> 00:25:12,891 TODAY I'LL TALK TO YOU ABOUT 676 00:25:12,891 --> 00:25:14,559 RESEARCH AND INTRODUCING YOU TO 677 00:25:14,559 --> 00:25:17,896 A YOUNG WOMAN WHO WAS INVOLVED 678 00:25:17,896 --> 00:25:20,132 IN NIH STUDY. 679 00:25:20,132 --> 00:25:21,900 SO THE MISSION OF CEREBRAL PALSY 680 00:25:21,900 --> 00:25:23,368 FOUNDATION IS TO BE A CATALYST 681 00:25:23,368 --> 00:25:25,103 FOR CREATING POSITIVE CHANGE FOR 682 00:25:25,103 --> 00:25:26,071 PEOPLE LIVING WITH CEREBRAL 683 00:25:26,071 --> 00:25:27,239 PALSY AROUND THE WORLD. 684 00:25:27,239 --> 00:25:29,508 WE DO THIS TO A COMMIT GROUP OF 685 00:25:29,508 --> 00:25:30,842 STAFF VOLUNTEERS AND LEADERS 686 00:25:30,842 --> 00:25:33,979 FROM I DO VERSE BACK GROUNDS AND 687 00:25:33,979 --> 00:25:35,280 WE STRONGLY BELIEVE HOW WE THINK 688 00:25:35,280 --> 00:25:36,815 AND TALK ABOUT DISABILITIES 689 00:25:36,815 --> 00:25:38,250 MAKES A BIG DIFFERENCE IN HOW 690 00:25:38,250 --> 00:25:39,184 OTHER PEOPLE THINK AND TALK 691 00:25:39,184 --> 00:25:40,619 ABOUT DISABILITIES. 692 00:25:40,619 --> 00:25:42,521 SO THE PAST 70 YEARS, THE 693 00:25:42,521 --> 00:25:43,722 FOUNDATION HAS CHANGED AND 694 00:25:43,722 --> 00:25:44,823 DEVELOPED ACCORDING TO THE NEEDS 695 00:25:44,823 --> 00:25:46,992 OF INDIVIDUALS IN THEIR 696 00:25:46,992 --> 00:25:47,259 FAMILIES. 697 00:25:47,259 --> 00:25:48,627 IT WAS FIRST IMAGINED BY 698 00:25:48,627 --> 00:25:49,828 DEDICATED PARENTS WHO WANTED TO 699 00:25:49,828 --> 00:25:51,063 MAKE A DIFFERENCE. 700 00:25:51,063 --> 00:25:53,632 WE INITIALLY FOCUSED ON FUNDING 701 00:25:53,632 --> 00:25:55,033 INDIVIDUAL INVESTIGATORS IN 702 00:25:55,033 --> 00:25:56,301 ACADEMIC RESEARCH, SOME OF THEM 703 00:25:56,301 --> 00:25:59,137 YOU WILL HEAR OVER THE NEXT TWO 704 00:25:59,137 --> 00:25:59,337 DAYS. 705 00:25:59,337 --> 00:26:01,239 NOW SUPPORTING LARGE NETWORKS 706 00:26:01,239 --> 00:26:02,808 AND THESE NETWORKS CAN NOW 707 00:26:02,808 --> 00:26:05,310 EMBRACE THE ACADEMIC AND 708 00:26:05,310 --> 00:26:06,611 IMPLEMENTATION RESEARCH THAT IS 709 00:26:06,611 --> 00:26:10,782 NEEDED TO MAKE THE GREATEST 710 00:26:10,782 --> 00:26:11,516 IMPACT. 711 00:26:11,516 --> 00:26:14,453 SO WE HAVE FOUR MAJOR AREAS WE 712 00:26:14,453 --> 00:26:15,287 WORK IN. 713 00:26:15,287 --> 00:26:17,089 THE FIRST THING HEALTH, THE 714 00:26:17,089 --> 00:26:20,158 SECOND EDUCATION, THE THIRD 715 00:26:20,158 --> 00:26:21,827 ADVOCACY AND THE LAST ONE DESIGN 716 00:26:21,827 --> 00:26:23,361 TECHNOLOGY AND WE ENABLE THIS 717 00:26:23,361 --> 00:26:25,730 REAL WORLD IMPACT THROUGH THE 718 00:26:25,730 --> 00:26:27,499 RESEARCH AND AN ORGANIZATION 719 00:26:27,499 --> 00:26:30,635 FROM AROUND THE WORLD. 720 00:26:30,635 --> 00:26:32,904 SO WE CURRENTLY HAVE OVER 100 721 00:26:32,904 --> 00:26:35,907 PARTNERS THAT WE ARE WORKING 722 00:26:35,907 --> 00:26:36,108 WITH. 723 00:26:36,108 --> 00:26:38,844 WE HAVE 150 INDIVIDUALS IN OUR 724 00:26:38,844 --> 00:26:40,679 PROGRAMS TO OUR SOCIAL MEDIA AND 725 00:26:40,679 --> 00:26:42,614 COMMUNITY OUTREACH WE REACH OVER 726 00:26:42,614 --> 00:26:44,416 300,000 PEOPLE AROUND THE WORLD 727 00:26:44,416 --> 00:26:46,184 WEEKLY AND WE HAVE INVESTED IN 728 00:26:46,184 --> 00:26:51,289 BOTH RESEARCH INNOVATION, 729 00:26:51,289 --> 00:26:51,656 IMPLEMENTATION. 730 00:26:51,656 --> 00:26:52,924 SO AS I SAID, WE HAVE REALLY 731 00:26:52,924 --> 00:26:55,060 MOVED OUR MODEL TO NETWORKS OF 732 00:26:55,060 --> 00:26:55,293 CHANGE. 733 00:26:55,293 --> 00:26:56,728 THESE NETWORKS OF CHANGE ARE 734 00:26:56,728 --> 00:26:58,130 DESIGNED TO IDENTIFY BIG 735 00:26:58,130 --> 00:26:58,630 PROBLEMS. 736 00:26:58,630 --> 00:27:00,065 AND WHAT WE'RE DOING IS WE'RE 737 00:27:00,065 --> 00:27:01,566 COMMITTED TO CONNECT INDUSTRY 738 00:27:01,566 --> 00:27:03,368 PARTNERS WITH RESEARCHERS, WITH 739 00:27:03,368 --> 00:27:05,270 PRACTITIONERS AND ADMINISTRATORS 740 00:27:05,270 --> 00:27:06,771 AND OF COURSE INDIVIDUALS AND 741 00:27:06,771 --> 00:27:08,440 THEIR FAMILIES TO DRIVE THE BEST 742 00:27:08,440 --> 00:27:09,274 POSSIBLE OUTCOMES. 743 00:27:09,274 --> 00:27:11,042 AND SO WHEN WE THINK ABOUT THESE 744 00:27:11,042 --> 00:27:13,778 NETWORKS OF CHANGE, WE LOOK AT 745 00:27:13,778 --> 00:27:14,946 FOUR KEY POINTS. 746 00:27:14,946 --> 00:27:15,881 FIRST BEING RESEARCH. 747 00:27:15,881 --> 00:27:17,649 HOW DO WE GET INVOLVED IN 748 00:27:17,649 --> 00:27:19,551 RESEARCH AND MAKE SURE THE 749 00:27:19,551 --> 00:27:20,519 STAKEHOLDER DRIVEN AND OVER THE 750 00:27:20,519 --> 00:27:22,053 PAST THREE YEARS, WE'VE ACTUALLY 751 00:27:22,053 --> 00:27:23,855 BEEN INVOLVED IN AROUND 15 752 00:27:23,855 --> 00:27:26,758 STUDIES TO HELP WITH RECRUITMENT 753 00:27:26,758 --> 00:27:28,293 AND HELP WITH STUDY DESIGN. 754 00:27:28,293 --> 00:27:29,694 TO THINK ABOUT THE OUT COMES 755 00:27:29,694 --> 00:27:31,363 THAT FAMILIES AND INDIVIDUALS 756 00:27:31,363 --> 00:27:33,165 WITH CEREBRAL PALSY WANT TO SEE. 757 00:27:33,165 --> 00:27:34,699 AND THEN OF COURSE THE 758 00:27:34,699 --> 00:27:35,767 INFRASTRUCTURE AND 759 00:27:35,767 --> 00:27:36,601 IMPLEMENTATION THAT IS REQUIRED 760 00:27:36,601 --> 00:27:38,670 TO MAKE SURE THAT THIS RESEARCH 761 00:27:38,670 --> 00:27:42,908 IS GETTING TO THE INDIVIDUALS 762 00:27:42,908 --> 00:27:44,910 AND THEIR FAMILIES AS SOON AS 763 00:27:44,910 --> 00:27:45,177 POSSIBLE. 764 00:27:45,177 --> 00:27:47,479 AT THE SAME POLICY NEEDED AND 765 00:27:47,479 --> 00:27:49,548 THEN DISSEMINATION AND EDUCATION 766 00:27:49,548 --> 00:27:50,882 AND DISSEMINATION AND EDUCATION 767 00:27:50,882 --> 00:27:52,417 IS FOR CLINICIANS AND 768 00:27:52,417 --> 00:27:53,385 RESEARCHERS AND OF COURSE IT'S 769 00:27:53,385 --> 00:27:55,387 THE FAMILIES AND FOR INDIVIDUALS 770 00:27:55,387 --> 00:27:55,687 TOO. 771 00:27:55,687 --> 00:28:00,192 AND WE DO A LOT OF THAT THROUGH 772 00:28:00,192 --> 00:28:03,895 CP RERESOURCE.ORG. 773 00:28:03,895 --> 00:28:05,297 THERE ARE CEREBRAL PALSY EARLY 774 00:28:05,297 --> 00:28:06,498 DETECTION INTERVENTION NETWORK 775 00:28:06,498 --> 00:28:08,066 HAS BEEN AROUND FOR FIVE YEARS 776 00:28:08,066 --> 00:28:09,634 AND IT INITIALLY STARTED WITH 777 00:28:09,634 --> 00:28:11,903 FIVE SITES ACROSS THE COUNTRY. 778 00:28:11,903 --> 00:28:13,438 THESE FIVE SITES IN THE FIRST 12 779 00:28:13,438 --> 00:28:14,773 MONTHS WERE ABLE TO BRING THE 780 00:28:14,773 --> 00:28:16,908 AVERAGE AGE OF DIAGNOSIS TO NINE 781 00:28:16,908 --> 00:28:18,710 AND A HALF MONTHS ACROSS THE 782 00:28:18,710 --> 00:28:18,944 NETWORK. 783 00:28:18,944 --> 00:28:20,412 AND THIS WAS DONE THROUGH LOTS 784 00:28:20,412 --> 00:28:22,180 OF DIFFERENT IMPLEMENTATION 785 00:28:22,180 --> 00:28:24,049 PROCESSES, IMPLEMENTATION 786 00:28:24,049 --> 00:28:26,851 SCIENCE, AND QRA INITIATIVES. 787 00:28:26,851 --> 00:28:28,186 BUT OF COURSE, ONE OF OUR 788 00:28:28,186 --> 00:28:30,055 BIGGEST MISSIONS OF THE 789 00:28:30,055 --> 00:28:31,289 FOUNDATION IS TO THINGS IN 790 00:28:31,289 --> 00:28:32,891 SINGLE ELEMENTS AND LOCALLY BUT 791 00:28:32,891 --> 00:28:35,093 HOW DO WE ACTUALLY LOOK A LOT 792 00:28:35,093 --> 00:28:36,194 SCALING THINGS NATIONALLY AND 793 00:28:36,194 --> 00:28:37,862 INTERNATIONALLY AND HOW DO WE 794 00:28:37,862 --> 00:28:39,731 ALSO MAKE SURE THAT THESE THINGS 795 00:28:39,731 --> 00:28:41,900 CAN ACTUALLY HAVE SUSTAINABILITY 796 00:28:41,900 --> 00:28:44,369 OVER THE LONGER PERIOD OF TIME. 797 00:28:44,369 --> 00:28:46,271 SO, FIVE YEARS LATER, WE HAVE 798 00:28:46,271 --> 00:28:48,173 NOW NOT ONLY EXPANDED OUR 799 00:28:48,173 --> 00:28:49,207 NETWORK TO DIFFERENT SITES 800 00:28:49,207 --> 00:28:51,376 ACROSS THE COUNTRY, BUT WE'VE 801 00:28:51,376 --> 00:28:53,612 ALSO TRAINED MORE THAN 4,000 802 00:28:53,612 --> 00:28:54,879 PROVIDERS IN EARLY DETECTION 803 00:28:54,879 --> 00:28:58,250 TOOLS AND IMPLEMENTATION AND THE 804 00:28:58,250 --> 00:29:00,719 CO PI ON THIS PROJECT, YOU WILL 805 00:29:00,719 --> 00:29:02,354 HEAR MORE HOW SHE'S ABLE TO 806 00:29:02,354 --> 00:29:04,389 UTILIZE THE NETWORK FOR ONE OF 807 00:29:04,389 --> 00:29:07,125 HER STUDIES LATER ON TODAY. 808 00:29:07,125 --> 00:29:10,061 WE ALSO HELD OUR FIFTH ANNUAL 809 00:29:10,061 --> 00:29:11,496 EARLY CEREBRAL PALSY HEALTH 810 00:29:11,496 --> 00:29:14,933 SUMMIT THIS PAST WEEKEND IN 811 00:29:14,933 --> 00:29:16,101 ATLANTA, GEORGIA. 812 00:29:16,101 --> 00:29:17,969 >>> SO JUST TO REITERATE WHEN 813 00:29:17,969 --> 00:29:20,472 WE'RE THINKING ABOUT STAKEHOLDER 814 00:29:20,472 --> 00:29:22,707 PARTICIPATION, WE WANT TO BUILD 815 00:29:22,707 --> 00:29:24,009 EVIDENCE AND PRIORITIES WITH ALL 816 00:29:24,009 --> 00:29:25,910 STAKEHOLDERS AND MAKE SURE WE'RE 817 00:29:25,910 --> 00:29:26,978 ENGAGING STAKEHOLDERS IN 818 00:29:26,978 --> 00:29:28,280 INITIATIVE DESIGN AND OUTCOMES 819 00:29:28,280 --> 00:29:30,448 AND WE WANT TO MAKE SURE ALL 820 00:29:30,448 --> 00:29:32,550 STAKEHOLDERS ARE ACTUALLY 821 00:29:32,550 --> 00:29:38,523 PARTICIPATING IN THE RESEARCH AS 822 00:29:38,523 --> 00:29:38,723 WELL. 823 00:29:38,723 --> 00:29:39,691 SO IT'S MY PLEASURE TO INTRODUCE 824 00:29:39,691 --> 00:29:41,593 YOU TO A YOUNG WOMAN WHO IS 825 00:29:41,593 --> 00:29:43,795 RECENTLY PARTICIPATED IN AN NIH 826 00:29:43,795 --> 00:29:46,464 RESEARCH STUDY AND WE ALL KNOW 827 00:29:46,464 --> 00:29:47,966 THAT TEENS ARE UNDER REPRESENTED 828 00:29:47,966 --> 00:29:49,334 IN RESEARCH AND IT'S IMPORTANT 829 00:29:49,334 --> 00:29:51,202 FOR US TO LISTEN TO WHAT THEY 830 00:29:51,202 --> 00:29:53,638 HAVE TO SAY AND IT'S SUCH A 831 00:29:53,638 --> 00:29:55,407 CRITICAL TIME AS THEY TRANSITION 832 00:29:55,407 --> 00:29:57,075 TO ADULTHOOD AND WE KNOW THERE'S 833 00:29:57,075 --> 00:29:58,410 ACTUALLY CURRENTLY FEWER 834 00:29:58,410 --> 00:29:59,611 RESEARCH OPPORTUNITIES FOR THEM 835 00:29:59,611 --> 00:30:01,279 TO BE INVOLVED IN AND WE KNOW 836 00:30:01,279 --> 00:30:02,914 THERE'S ALSO SOMETIMES A 837 00:30:02,914 --> 00:30:04,916 BREAKDOWN IN CLINICAL CARE. 838 00:30:04,916 --> 00:30:07,285 WITH THAT, I WOULD LIKE TO 839 00:30:07,285 --> 00:30:09,554 INTRODUCE YOU TO CAYDANCE 840 00:30:09,554 --> 00:30:10,288 ANDERSON. 841 00:30:10,288 --> 00:30:11,456 A 15-YEAR-OLD WHO LIVES IN 842 00:30:11,456 --> 00:30:12,657 LOUISIANA WITH HER PARENTS AND 843 00:30:12,657 --> 00:30:13,958 HER TWO SISTERS. 844 00:30:13,958 --> 00:30:16,227 SHE IS STARTING HER SOFT MORE 845 00:30:16,227 --> 00:30:17,929 YEAR AT HIGH SCHOOL AND LOVES 846 00:30:17,929 --> 00:30:19,497 MUSIC AND SINGING. 847 00:30:19,497 --> 00:30:20,999 SHE HAS CEREBRAL PALSY AND WAS 848 00:30:20,999 --> 00:30:22,300 FORTUNATE ENOUGH TO BE DIAGNOSED 849 00:30:22,300 --> 00:30:24,169 SO SHE COULD BEGIN HER EARLY 850 00:30:24,169 --> 00:30:25,370 INTERSECTION IN THE SUPPORT OF 851 00:30:25,370 --> 00:30:26,338 HER FAMILY. 852 00:30:26,338 --> 00:30:28,807 WHEN SHE WAS 11 YEARS OLD SHE 853 00:30:28,807 --> 00:30:30,108 JOINED HER SCHOOL CROSS COUNTRY 854 00:30:30,108 --> 00:30:31,276 TEAM AND SHE'S BEEN BLESSED WITH 855 00:30:31,276 --> 00:30:33,044 A BEAUTIFUL SINGING VOICE THAT 856 00:30:33,044 --> 00:30:35,814 ALLOWED HER TO PARTICIPATE IN 857 00:30:35,814 --> 00:30:39,918 MUSIC GROUPS IN CONNECTION WITH 858 00:30:39,918 --> 00:30:43,121 A NEW ORLEANS. 859 00:30:43,121 --> 00:30:44,923 IN 2019 SHE JOINED AN NIH 860 00:30:44,923 --> 00:30:47,225 CEREBRAL PALSY RESEARCH STUDY AT 861 00:30:47,225 --> 00:30:49,627 LOUISIANA STATE UNIVERSITY WITH 862 00:30:49,627 --> 00:30:50,195 Dr. NOEL MORROW. 863 00:30:50,195 --> 00:30:52,731 IT FOCUSED ON POWER TRAINING AND 864 00:30:52,731 --> 00:30:55,200 THROUGH THIS STUDY, CAYDANCE 865 00:30:55,200 --> 00:30:56,034 REALIZED THROUGH EXERCISE SHE 866 00:30:56,034 --> 00:30:58,036 CAN BE STRONGER AND MORE 867 00:30:58,036 --> 00:30:59,738 SELF-SUFFICIENT AND SHE NOW 868 00:30:59,738 --> 00:31:01,806 WORKS OUT WITH A TRAINER AND 869 00:31:01,806 --> 00:31:03,108 ATTENDS PHYSICAL THERAPY ONCE A 870 00:31:03,108 --> 00:31:07,178 WEEK SO PLEASE JOIN ME IN 871 00:31:07,178 --> 00:31:07,612 WELCOMING CAYDANCE. 872 00:31:07,612 --> 00:31:07,812 >> HI. 873 00:31:07,812 --> 00:31:09,948 IT'S REALLY NICE TO BE HERE 874 00:31:09,948 --> 00:31:10,148 TODAY. 875 00:31:10,148 --> 00:31:12,117 SO, THE KIND OF CEREBRAL PALSY 876 00:31:12,117 --> 00:31:15,920 THAT I HAVE IS SPASTIC DIAPLEGI 877 00:31:15,920 --> 00:31:18,289 THAT EFFECTS BOTH OF MY LEGS AND 878 00:31:18,289 --> 00:31:20,592 IT'S VERY MILD. 879 00:31:20,592 --> 00:31:21,926 THE MAIN WAYS THAT CEREBRAL 880 00:31:21,926 --> 00:31:27,799 PALSY AFFECTS ME IS WALKING AND 881 00:31:27,799 --> 00:31:30,335 RUNNING ISN'T ALWAYS AS EASY FOR 882 00:31:30,335 --> 00:31:30,702 ME. 883 00:31:30,702 --> 00:31:32,103 MAYBE IF WE'RE DOING AN 884 00:31:32,103 --> 00:31:35,373 ACTIVITY, I MIGHT NOT BE ABLE TO 885 00:31:35,373 --> 00:31:37,008 PARTICIPATE IN IT, BUT JUST 886 00:31:37,008 --> 00:31:39,878 THINGS LIKE THAT NORMALLY. 887 00:31:39,878 --> 00:31:42,981 NORMALLY I DO PARTICIPATE IN 888 00:31:42,981 --> 00:31:46,017 FIGURE OUT A WAY AROUND IT AND 889 00:31:46,017 --> 00:31:48,520 AROUND TWO-YEARS-OLD I GUESS 890 00:31:48,520 --> 00:31:52,257 REALIZED WHAT WAS GOING ON SO I 891 00:31:52,257 --> 00:31:54,159 WAS FORT ENOUGH TO GET INTO 892 00:31:54,159 --> 00:32:01,332 EARLY ON IN MY LIFE AND WHEN I 893 00:32:01,332 --> 00:32:02,834 WAS GROWING UP I WENT EVERYDAY. 894 00:32:02,834 --> 00:32:06,237 NOW I GO ONCE A WEEK AND I DID A 895 00:32:06,237 --> 00:32:07,806 LOT OF ACTIVITIES GROWING UP AND 896 00:32:07,806 --> 00:32:10,275 I WAS REALLY ACTIVE IN SCHOOL 897 00:32:10,275 --> 00:32:12,410 AND IN SPORTS AND JUST THINGS 898 00:32:12,410 --> 00:32:15,313 LIKE THAT. 899 00:32:15,313 --> 00:32:17,315 WHEN I WAS AROUND SIX TO 10 900 00:32:17,315 --> 00:32:22,053 YEARS OF AGE AND I STARTED 901 00:32:22,053 --> 00:32:23,588 WEARING BRACES ON MY LEGS. 902 00:32:23,588 --> 00:32:24,789 WE NEVER THOUGHT ABOUT SURGERY 903 00:32:24,789 --> 00:32:27,258 AND I NEVER WAS BIG ON THAT AND 904 00:32:27,258 --> 00:32:29,160 I DIDN'T REALLY WANT TO DO IT. 905 00:32:29,160 --> 00:32:32,096 I JUST FOUND OUT THAT THERE WERE 906 00:32:32,096 --> 00:32:33,531 WAYS, OTHER WAYS I COULD 907 00:32:33,531 --> 00:32:35,533 STRENGTHEN MYSELF WITHOUT 908 00:32:35,533 --> 00:32:45,910 SURGERY AND I USED TO WEAR 909 00:32:45,910 --> 00:32:46,978 ORTHOTICS ON MY LEGS. 910 00:32:46,978 --> 00:32:48,046 I USED TO EXPERIENCE PAIN. 911 00:32:48,046 --> 00:32:50,148 I COULD NOT SIT ON MY LEGS OR 912 00:32:50,148 --> 00:32:51,316 SQUAT ON THE GROUND. 913 00:32:51,316 --> 00:32:53,685 IT WOULD HURT REALLY BAD AND I 914 00:32:53,685 --> 00:32:55,987 WAS NOT ABLE TO DO THAT AND 915 00:32:55,987 --> 00:32:57,689 THROUGH STRENGTH TRAINING AND 916 00:32:57,689 --> 00:32:58,890 PHYSICAL THERAPY, I CAN DO ALL 917 00:32:58,890 --> 00:33:01,025 OF THOSE THINGS NOW WITHOUT ANY 918 00:33:01,025 --> 00:33:01,226 PAIN. 919 00:33:01,226 --> 00:33:03,161 I REALLY HAVE TO FOCUS ON 920 00:33:03,161 --> 00:33:04,429 GETTING STRONGER ALSO FOR WHAT I 921 00:33:04,429 --> 00:33:06,397 GET OLDER AND MY BONES GET 922 00:33:06,397 --> 00:33:06,931 WEAKER. 923 00:33:06,931 --> 00:33:09,734 SO I'M NOT LIKE UNABLE TO DO 924 00:33:09,734 --> 00:33:11,436 ANYTHING. 925 00:33:11,436 --> 00:33:13,771 SO, I NEVER THOUGHT -- I USED TO 926 00:33:13,771 --> 00:33:15,406 EXPERIENCE A LOT OF PAIN BUT 927 00:33:15,406 --> 00:33:17,075 Dr. NOEL AND THE TEAM, THEY 928 00:33:17,075 --> 00:33:19,077 REALLY HELPED ME FIGURE OUT WHAT 929 00:33:19,077 --> 00:33:21,012 I COULD DO TO FIX THINGS LIKE 930 00:33:21,012 --> 00:33:23,281 THAT AND SO I WOULDN'T BE IN SO 931 00:33:23,281 --> 00:33:24,449 MUCH PAIN ANYMORE. 932 00:33:24,449 --> 00:33:27,085 YES, SO, I WOULD GO TWICE A WEEK 933 00:33:27,085 --> 00:33:30,588 TO LSU. 934 00:33:30,588 --> 00:33:33,191 THIS STUDY WAS, WE WOULD DO 935 00:33:33,191 --> 00:33:35,393 STRENGTH TRAINING. 936 00:33:35,393 --> 00:33:38,062 I THINK -- I REALLY LOVE A TEAM 937 00:33:38,062 --> 00:33:38,296 THERE. 938 00:33:38,296 --> 00:33:39,998 WE ALL BECAME A BIG FAMILY AND 939 00:33:39,998 --> 00:33:42,433 IT WAS REALLY NILES TO SEE THAT 940 00:33:42,433 --> 00:33:43,835 THERE WERE PEOPLE WHO KNEW WHAT 941 00:33:43,835 --> 00:33:45,970 WAS GOING ON -- I MEAN I'VE GONE 942 00:33:45,970 --> 00:33:47,272 TO PHYSICAL THERAPY ALL MY LIFE 943 00:33:47,272 --> 00:33:50,675 BUT PEOPLE WHO WERE -- REALLY 944 00:33:50,675 --> 00:33:52,677 KNEW WHAT WAS GOING ON AND THEY 945 00:33:52,677 --> 00:33:54,078 FOCUSED ON THAT ONE ASPECT OF 946 00:33:54,078 --> 00:33:57,382 WHAT WAS GOING ON WITH ME AND WE 947 00:33:57,382 --> 00:33:59,384 DID STRENGTH TRAINING AND WE 948 00:33:59,384 --> 00:34:02,220 WOULD DO PUSH UPS ON THIS THING 949 00:34:02,220 --> 00:34:07,292 WHERE YOU WOULD USE YOUR LEGS 950 00:34:07,292 --> 00:34:08,960 AND I WOULD BE TIMED WALKING AND 951 00:34:08,960 --> 00:34:09,994 IT WAS A CHALLENGE. 952 00:34:09,994 --> 00:34:12,063 YOU CAN'T RUN BUT YOU HAVE TO 953 00:34:12,063 --> 00:34:12,330 SEE. 954 00:34:12,330 --> 00:34:13,965 IT WOULD SHOW ME HOW MUCH I'VE 955 00:34:13,965 --> 00:34:15,233 GROWN OVER THE WEEKS, SEEING IF 956 00:34:15,233 --> 00:34:18,336 I COULD MAKE IT TO THIS MARK. 957 00:34:18,336 --> 00:34:20,805 THIS WEEK AND IF I DIDN'T MAKE 958 00:34:20,805 --> 00:34:22,874 IT TO THAT MARK BEFORE. 959 00:34:22,874 --> 00:34:26,945 AND WE WOULD RUN OBJECT A 960 00:34:26,945 --> 00:34:28,313 TREADMILL AND PRACTICE STAMINA 961 00:34:28,313 --> 00:34:29,881 WITH ME RUNNING. 962 00:34:29,881 --> 00:34:34,485 NOT FALLING OVER EASIER, I 963 00:34:34,485 --> 00:34:34,752 GUESS. 964 00:34:34,752 --> 00:34:37,455 JUST LIKE GETTING MY STRENGTH UP 965 00:34:37,455 --> 00:34:39,090 AND SHOWING ME LIKE IF YOU 966 00:34:39,090 --> 00:34:40,391 THOUGHT YOU COULDN'T DO THIS 967 00:34:40,391 --> 00:34:42,026 WELL YOU CAN, IT JUST TAKES 968 00:34:42,026 --> 00:34:43,361 PRACTICE AND TIME. 969 00:34:43,361 --> 00:34:44,596 BECAUSE IN PHYSICAL THERAPY WE 970 00:34:44,596 --> 00:34:47,332 WOULD JUST DO THE SAME THING 971 00:34:47,332 --> 00:34:47,732 EVERYDAY. 972 00:34:47,732 --> 00:34:51,569 BUT WITH THIS STUDY, I WAS ABLE 973 00:34:51,569 --> 00:34:53,271 TO BE EDUCATED AND ABLE TO 974 00:34:53,271 --> 00:34:54,939 EDUCATE THEM, LIKE WHILE BEING 975 00:34:54,939 --> 00:34:57,108 IN THEIR STUDY, I GUESS. 976 00:34:57,108 --> 00:35:03,247 SO THAT WAS REALLY BIG AND I 977 00:35:03,247 --> 00:35:04,916 LEARNED A LOT ABOUT IT. 978 00:35:04,916 --> 00:35:06,918 I THOUGHT IT WAS JUST ME WHO HAD 979 00:35:06,918 --> 00:35:09,087 IT AND I WAS JUST AN UNLUCKY 980 00:35:09,087 --> 00:35:09,821 PERSON. 981 00:35:09,821 --> 00:35:10,288 THERE'S NOT. 982 00:35:10,288 --> 00:35:11,789 THERE'S A BUNCH OF PEOPLE WHO 983 00:35:11,789 --> 00:35:12,323 HAVE IT. 984 00:35:12,323 --> 00:35:15,326 I DID NOT KNOW NINE WAS MILD AND 985 00:35:15,326 --> 00:35:16,961 SOME PEOPLE HAVE IT A LOT WORSE 986 00:35:16,961 --> 00:35:19,130 THAN ME, I GUESS YOU COULD SAY. 987 00:35:19,130 --> 00:35:21,866 I LEARNED THAT I COULD LIKE RUN 988 00:35:21,866 --> 00:35:22,667 PRETTY WELL. 989 00:35:22,667 --> 00:35:27,005 I HAD GOOD STAMINA. 990 00:35:27,005 --> 00:35:28,873 I LEARNED THAT I COULD WORK ON 991 00:35:28,873 --> 00:35:30,575 MY BALANCE A LOT. 992 00:35:30,575 --> 00:35:36,981 THAT WOULD HELP ALSO. 993 00:35:36,981 --> 00:35:38,516 >> I WAS REALLY STRONG IN MY 994 00:35:38,516 --> 00:35:40,618 LEGS I JUST NEVER KNEW IT. 995 00:35:40,618 --> 00:35:42,086 THEY REALLY HELPED ME FIND OUT A 996 00:35:42,086 --> 00:35:47,992 LOT ABOUT MYSELF. 997 00:35:47,992 --> 00:35:49,627 I LEARNED IF YOU RUN FOR TWO 998 00:35:49,627 --> 00:35:51,429 MINUTES AND WALK 30 SECONDS IT 999 00:35:51,429 --> 00:35:55,333 REALLY HELPS BUILDUP YOUR 1000 00:35:55,333 --> 00:35:56,634 STAMINA AND IT HELPED ME A LOT 1001 00:35:56,634 --> 00:35:59,704 WITH MY BALANCE. 1002 00:35:59,704 --> 00:36:01,005 I LEARNED THAT SITTING AND 1003 00:36:01,005 --> 00:36:02,774 STANDING IS NOT AS HARD AS I 1004 00:36:02,774 --> 00:36:04,208 THOUGHT IT WAS. 1005 00:36:04,208 --> 00:36:05,977 AND NOW THANKS TO THE STUDY AND 1006 00:36:05,977 --> 00:36:08,146 PHYSICAL THERAPY, I CAN DO THAT 1007 00:36:08,146 --> 00:36:11,315 WITHOUT A PROBLEM. 1008 00:36:11,315 --> 00:36:12,850 ALSO, GETTING OFF THE GROUND AND 1009 00:36:12,850 --> 00:36:16,287 MY BALANCE, THAT IS WAY EASIER 1010 00:36:16,287 --> 00:36:16,454 NOW. 1011 00:36:16,454 --> 00:36:19,023 I DON'T HAVE ANY SORT OF 1012 00:36:19,023 --> 00:36:19,957 PROBLEMS WITH THAT. 1013 00:36:19,957 --> 00:36:23,027 I FEEL LIKE THE BENEFITS OF THE 1014 00:36:23,027 --> 00:36:24,228 STUDY, THEY'VE STUCK WITH ME. 1015 00:36:24,228 --> 00:36:25,663 I DIDN'T JUST LOSE THEM. 1016 00:36:25,663 --> 00:36:32,870 BUT I ALSO THINK THAT IS PART OF 1017 00:36:32,870 --> 00:36:34,806 THE FACT I WAS ABLE TO BRING THE 1018 00:36:34,806 --> 00:36:36,507 SKILLS I LEARNED IN PHYSICAL 1019 00:36:36,507 --> 00:36:38,743 THERAPY AND SO I CAN DO THIS NOW 1020 00:36:38,743 --> 00:36:40,778 AND I CAN BUILD ON TOP OF THIS. 1021 00:36:40,778 --> 00:36:42,814 I WAS ALWAYS LIKE OH, NO, I'M 1022 00:36:42,814 --> 00:36:44,048 NOT GOING TO DO THAT. 1023 00:36:44,048 --> 00:36:45,783 NOW I'M LIKE, LET ME DO IT, I 1024 00:36:45,783 --> 00:36:46,684 CAN DO IT. 1025 00:36:46,684 --> 00:36:49,287 IT'S NOT REALLY -- THINGS I USED 1026 00:36:49,287 --> 00:36:50,722 TO BE NERVOUS ABOUT LIKE RUNNING 1027 00:36:50,722 --> 00:36:52,623 OR WALKING UP THE STAIRS, I CAN 1028 00:36:52,623 --> 00:36:54,258 DO THAT WITHOUT A PROBLEM NOW. 1029 00:36:54,258 --> 00:36:56,327 AND IT JUST MADE ME REALIZE, 1030 00:36:56,327 --> 00:37:00,465 LIKE, I NEED TO STOP HOLDING 1031 00:37:00,465 --> 00:37:02,366 MYSELF BACK FROM BRINGS AND I 1032 00:37:02,366 --> 00:37:03,901 NEED TO TRY AND EXPERIENCE NEW 1033 00:37:03,901 --> 00:37:04,135 THINGS. 1034 00:37:04,135 --> 00:37:06,404 I THINK THAT IT IMPROVED MY 1035 00:37:06,404 --> 00:37:08,072 RELATIONSHIPS WITH MY FAMILY, 1036 00:37:08,072 --> 00:37:09,974 BECAUSE THEY ALWAYS WOULD BE 1037 00:37:09,974 --> 00:37:12,510 LIKE HOLD YOURSELF BACK AND I'M 1038 00:37:12,510 --> 00:37:14,178 LIKE IT'S FINE, I'M NOT GOING TO 1039 00:37:14,178 --> 00:37:15,980 DO THAT AND I CAN'T DO THAT. 1040 00:37:15,980 --> 00:37:18,149 BUT MY MOM WAS VERY PROUD OF ME 1041 00:37:18,149 --> 00:37:21,152 THAT I PARTICIPATED IN IT 1042 00:37:21,152 --> 00:37:24,155 BECAUSE, YOU KNOW, I WAS LIKE, A 1043 00:37:24,155 --> 00:37:25,923 PRE-TEEN I DID NOT WANT TO DO 1044 00:37:25,923 --> 00:37:27,458 SOMETHING LIKE THAT. 1045 00:37:27,458 --> 00:37:30,862 I THINK IT IMPROVED MY 1046 00:37:30,862 --> 00:37:31,929 RELATIONSHIP WITH MY FAMILY. 1047 00:37:31,929 --> 00:37:32,997 THEY WERE PROUD OF ME. 1048 00:37:32,997 --> 00:37:34,432 I THINK WHETHER I DID IT OR NOT, 1049 00:37:34,432 --> 00:37:35,867 THEY WOULD BE PROUD OF ME. 1050 00:37:35,867 --> 00:37:37,902 JUST KNOWING THAT I WAS LIKABLE 1051 00:37:37,902 --> 00:37:40,238 TO TRY SOMETHING NEW AND I 1052 00:37:40,238 --> 00:37:41,806 LEARNED SO MUCH ABOUT MYSELF 1053 00:37:41,806 --> 00:37:45,109 THAT I WAS ABLE TO TEACH THEM AS 1054 00:37:45,109 --> 00:37:45,510 WELL. 1055 00:37:45,510 --> 00:37:46,377 THAT REALLY HELPED. 1056 00:37:46,377 --> 00:37:48,146 I THINK THEY DID A GREAT JOB 1057 00:37:48,146 --> 00:37:50,882 WITH MAKING IT APPEALING TO ME 1058 00:37:50,882 --> 00:37:52,917 AND THEY ALWAYS HAD A NEW TOPIC 1059 00:37:52,917 --> 00:37:57,355 TO TALK ABOUT. 1060 00:37:57,355 --> 00:37:59,023 I REMEMBER THE TEEN, THE GUY A 1061 00:37:59,023 --> 00:38:00,858 THAT I MAINLY WORKED WITH, HE 1062 00:38:00,858 --> 00:38:04,195 WOULD ALWAYS TALK ABOUT HIS PUGS 1063 00:38:04,195 --> 00:38:07,231 AND HIS FAMILY AND IT WAS REALLY 1064 00:38:07,231 --> 00:38:09,267 FUNNY AND LIKE, WE WOULD ALWAYS 1065 00:38:09,267 --> 00:38:11,803 WATCH MOVIES WHILE DOING STUFF. 1066 00:38:11,803 --> 00:38:14,405 I HAD TO LIKE WORKOUT WHILE 1067 00:38:14,405 --> 00:38:15,973 WATCHING MOVIES AND THEN IF I 1068 00:38:15,973 --> 00:38:17,441 WASN'T DOING IT OR IF I GOT 1069 00:38:17,441 --> 00:38:20,011 CAUGHT UP, I WOULD PAUSE THE 1070 00:38:20,011 --> 00:38:22,046 MOVIE AND BE LIKE YOU NEED TO DO 1071 00:38:22,046 --> 00:38:23,347 THIS. 1072 00:38:23,347 --> 00:38:26,884 Dr. NOEL HAS SUCH A BIG HEART. 1073 00:38:26,884 --> 00:38:28,886 IT WAS REALLY NICE WORKING WITH 1074 00:38:28,886 --> 00:38:32,056 HER AND HER BEING -- BOTH OF 1075 00:38:32,056 --> 00:38:33,724 THEM BEING SO EDUCATED ON WHAT 1076 00:38:33,724 --> 00:38:34,826 WAS GOING ON. 1077 00:38:34,826 --> 00:38:36,360 WHAT I WOULD TELL TO LIKE 1078 00:38:36,360 --> 00:38:39,297 ANOTHER PRE-TEEN THAT MIGHT BE 1079 00:38:39,297 --> 00:38:40,731 DOING THIS STUDY, YOU HAVE TO 1080 00:38:40,731 --> 00:38:43,501 THINK ABOUT THE LITTLE KIDS AND 1081 00:38:43,501 --> 00:38:44,936 THE FAMILIES WHO HAVE NO IDEAS 1082 00:38:44,936 --> 00:38:46,938 WHAT IS WRONG WITH THEIR CHILD 1083 00:38:46,938 --> 00:38:49,941 AND HOW MUCH YOU COULD EDUCATE 1084 00:38:49,941 --> 00:38:51,342 THEM ON THAT AND HOW MUCH YOU 1085 00:38:51,342 --> 00:38:54,078 COULD HELP THEM IN THE FUTURE. 1086 00:38:54,078 --> 00:38:55,346 BECAUSE YOU WERE HELPED, SO YOU 1087 00:38:55,346 --> 00:38:58,649 COULD ALSO HELP THEM. 1088 00:38:58,649 --> 00:39:00,551 I THINK THE BEST THING IS 1089 00:39:00,551 --> 00:39:03,054 REALIZING HOW MANY FAMILIES I 1090 00:39:03,054 --> 00:39:04,822 HELPED AND HOW MANY KIDS I 1091 00:39:04,822 --> 00:39:06,958 HELPED REALIZE HOW THEY CAN 1092 00:39:06,958 --> 00:39:08,626 STRENGTHEN THEIR SELVES AND BE 1093 00:39:08,626 --> 00:39:10,428 LIKE OH LIKE YOU CAN DO THIS. 1094 00:39:10,428 --> 00:39:12,463 YOU DO NOT HAVE TO HOLD YOURSELF 1095 00:39:12,463 --> 00:39:12,797 BACK. 1096 00:39:12,797 --> 00:39:16,000 AND ALSO, LEARNING STUFF, NEW 1097 00:39:16,000 --> 00:39:17,435 THINGS ABOUT MYSELF. 1098 00:39:17,435 --> 00:39:20,104 IT WAS REALLY EXCITING. 1099 00:39:20,104 --> 00:39:22,773 I DIDN'T KNOW THAT LIKE YOU 1100 00:39:22,773 --> 00:39:23,541 COULD USE LIKE WEIGHTS OR I 1101 00:39:23,541 --> 00:39:25,076 DIDN'T THINK MY LEGS COULD 1102 00:39:25,076 --> 00:39:27,378 HANDLE THAT AND I HAD ALWAYS 1103 00:39:27,378 --> 00:39:27,745 JUST EXERCISED. 1104 00:39:27,745 --> 00:39:30,514 I DIDN'T REALLY DO ANYTHING LIKE 1105 00:39:30,514 --> 00:39:31,849 THAT DIFFICULT AND IT WAS REALLY 1106 00:39:31,849 --> 00:39:33,751 HARD WHEN I FIRST STARTED OUT 1107 00:39:33,751 --> 00:39:36,821 BUT LIKE, YOU KNOW, NOW I CAN DO 1108 00:39:36,821 --> 00:39:38,823 THINGS LIKE THAT EASIER, I 1109 00:39:38,823 --> 00:39:39,056 GUESS. 1110 00:39:39,056 --> 00:39:41,325 I LOVE THE STUDY BUT I THINK 1111 00:39:41,325 --> 00:39:43,194 ABOUT HARDEST PART WAS THAT, I 1112 00:39:43,194 --> 00:39:46,364 REALLY STRUGGLED WITH SOMETHING 1113 00:39:46,364 --> 00:39:46,564 ELSE. 1114 00:39:46,564 --> 00:39:48,065 I WOULD STRUGGLE WITH SOMETHING 1115 00:39:48,065 --> 00:39:49,734 IF Dr. NOEL WOULD SAY FINE 1116 00:39:49,734 --> 00:39:51,569 TAKE A BREAK AND SHE WOULD BE 1117 00:39:51,569 --> 00:39:53,404 LIKE NOW WE'LL PUT MORE ON TOP 1118 00:39:53,404 --> 00:39:54,739 OF THAT AND CAN YOU DO THIS. 1119 00:39:54,739 --> 00:39:55,806 I ALWAYS DID IT. 1120 00:39:55,806 --> 00:39:57,842 THEY WEREN'T PUSHING ME TO MY 1121 00:39:57,842 --> 00:39:58,042 LIMIT. 1122 00:39:58,042 --> 00:40:04,415 IT WAS JUST LIKE, PLEASE, 1123 00:40:04,415 --> 00:40:06,450 LIKE -- I HAVE AMAZING FRIENDS. 1124 00:40:06,450 --> 00:40:08,452 I HANGOUT WITH MY FRIENDS LIKE 1125 00:40:08,452 --> 00:40:11,656 ALL SUMMER AND SCHOOL YEAR. 1126 00:40:11,656 --> 00:40:13,791 SO, THEY KNEW WHAT I WAS DOING. 1127 00:40:13,791 --> 00:40:17,728 THEY CAN DO THEIR PLANS WITHOUT 1128 00:40:17,728 --> 00:40:19,063 ME, I'M OK WITH THAT. 1129 00:40:19,063 --> 00:40:20,932 IT'S WORTH IT IN THE END. 1130 00:40:20,932 --> 00:40:22,867 I DIDN'T REALLY MISS OUT ON 1131 00:40:22,867 --> 00:40:23,267 ANYTHING. 1132 00:40:23,267 --> 00:40:26,737 I DIDN'T MISS OUT ON SLEEPOVERS 1133 00:40:26,737 --> 00:40:29,373 OR HANGOUT IN GENERAL. 1134 00:40:29,373 --> 00:40:31,409 MY FRIENDS COULD WAIT UNTIL I 1135 00:40:31,409 --> 00:40:33,044 WAS DONE WITH WHAT I HAD TO DO 1136 00:40:33,044 --> 00:40:34,578 TO HANGOUT WITH THEM. 1137 00:40:34,578 --> 00:40:36,814 I THINK I WOULD LOVE TO BE A 1138 00:40:36,814 --> 00:40:38,449 PART OF LIKE A FOLLOW-UP STUDY 1139 00:40:38,449 --> 00:40:40,451 TO SEE HOW I HAVE CARRIED ON 1140 00:40:40,451 --> 00:40:43,087 WITH WHAT THEY SHOWED ME HOW TO 1141 00:40:43,087 --> 00:40:43,321 DO. 1142 00:40:43,321 --> 00:40:44,956 I THINK THAT WOULD BE A REALLY 1143 00:40:44,956 --> 00:40:46,791 COOL EXPERIENCE AND I THINK IT 1144 00:40:46,791 --> 00:40:48,459 WOULD HELP MYSELF BUT ALSO A LOT 1145 00:40:48,459 --> 00:40:50,127 OF OTHER PEOPLE. 1146 00:40:50,127 --> 00:40:51,395 AND IN THE FUTURE, I THINK I 1147 00:40:51,395 --> 00:40:53,664 WOULD LOVE TO BE A PART OF ANY 1148 00:40:53,664 --> 00:40:55,099 STUDY THAT INVOLVES CEREBRAL 1149 00:40:55,099 --> 00:40:55,333 PALSY. 1150 00:40:55,333 --> 00:40:59,003 I THINK I WOULD ALSO REALLY LIKE 1151 00:40:59,003 --> 00:41:01,172 TO WORK ALONGSIDE SOMEONE ELSE 1152 00:41:01,172 --> 00:41:04,008 WHO HAS IT AND SEEING HOW WELL 1153 00:41:04,008 --> 00:41:08,479 WE CAN HELP EACH OTHER ALONG 1154 00:41:08,479 --> 00:41:09,880 WITH THE DISTRICTORS HELPING US 1155 00:41:09,880 --> 00:41:10,114 AS WELL. 1156 00:41:10,114 --> 00:41:11,816 I WOULD LOVE TO BE A PART OF 1157 00:41:11,816 --> 00:41:13,484 ANOTHER STUDY EVEN IF IT'S ON A 1158 00:41:13,484 --> 00:41:14,418 DIFFERENT TOPIC. 1159 00:41:14,418 --> 00:41:16,620 I WOULD REALLY LIKE THAT. I 1160 00:41:16,620 --> 00:41:18,155 THINK I WOULD WANT THEM TO KNOW 1161 00:41:18,155 --> 00:41:19,457 THAT THEY'RE HELPING A LOT OF 1162 00:41:19,457 --> 00:41:22,059 FAMILIES INCLUDING MINE. 1163 00:41:22,059 --> 00:41:23,494 AND THAT THEY'VE GATHERED A LOT 1164 00:41:23,494 --> 00:41:26,130 OF REALLY GOOD RESEARCH AND 1165 00:41:26,130 --> 00:41:28,432 THEY'RE STILL GATHERING MORE AND 1166 00:41:28,432 --> 00:41:31,168 I THINK IT'S REALLY EXCITING HOW 1167 00:41:31,168 --> 00:41:32,903 THEY HAVE LIKE FACES LIKE MINE 1168 00:41:32,903 --> 00:41:34,705 AND PEOPLE LIKE ME WITH CEREBRAL 1169 00:41:34,705 --> 00:41:38,609 PALSY WHO HAVE IT FIRSTHAND. 1170 00:41:38,609 --> 00:41:40,611 EDUCATING THEM AND EDUCATING 1171 00:41:40,611 --> 00:41:44,482 FAMILIES WITH KIDS WHO MIGHT 1172 00:41:44,482 --> 00:41:45,783 HAVE IT ON WHAT IT IS. 1173 00:41:45,783 --> 00:41:47,752 I THINK THE RESEARCH THAT THEY 1174 00:41:47,752 --> 00:41:50,121 HAVE ON IT IS REALLY GOOD. 1175 00:41:50,121 --> 00:41:52,356 SO, FUTURE RESEARCH THAT I WOULD 1176 00:41:52,356 --> 00:41:56,460 WANT TO SEE IS MAYBE LIKE MORE 1177 00:41:56,460 --> 00:41:58,062 STRENGTH TRAINING THAN I'VE DONE 1178 00:41:58,062 --> 00:41:59,864 BEFORE AND I THINK THAT WOULD BE 1179 00:41:59,864 --> 00:42:01,999 REALLY COOL TO SEE AND I LIKE 1180 00:42:01,999 --> 00:42:03,434 SEEING PROGRESS AND I THINK IT 1181 00:42:03,434 --> 00:42:05,803 COULD ALSO LIKE UP LIFT FAMILIES 1182 00:42:05,803 --> 00:42:09,740 SEEING MY PROGRESS AND OTHER 1183 00:42:09,740 --> 00:42:10,775 KIDS' PROGRESS THAT THEY'VE 1184 00:42:10,775 --> 00:42:12,076 GOTTEN FROM THIS STUDY. 1185 00:42:12,076 --> 00:42:13,878 SO I WOULD WANT TO DO MORE 1186 00:42:13,878 --> 00:42:15,279 STRENGTH TRAINING AND SEEING HOW 1187 00:42:15,279 --> 00:42:17,982 WELL I'VE GROWN. 1188 00:42:17,982 --> 00:42:22,553 WHEN I GROW UP, I WANT TO BE A 1189 00:42:22,553 --> 00:42:23,287 SPOKESPERSON ABOUT CEREBRAL 1190 00:42:23,287 --> 00:42:23,888 PALSY ACTUALLY. 1191 00:42:23,888 --> 00:42:25,089 I'M NOT JUST SAYING THAT. 1192 00:42:25,089 --> 00:42:27,892 I THINK IT WOULD BE REALLY DOOL 1193 00:42:27,892 --> 00:42:29,360 SEE LIKE ME WHO ARE HAS IT, WHO 1194 00:42:29,360 --> 00:42:32,797 HAS IT, DO RESEARCH ON IT AND 1195 00:42:32,797 --> 00:42:34,331 SHARING MY STORY WITH KIDS AND 1196 00:42:34,331 --> 00:42:35,766 BEING LIKE THERE IS A LIGHT AT 1197 00:42:35,766 --> 00:42:38,636 THE END OF THE TUNNEL. 1198 00:42:38,636 --> 00:42:43,107 THIS DUDOES NOT DEFINE YOU OR IO 1199 00:42:43,107 --> 00:42:51,282 BE A LAWYER. 1200 00:42:51,282 --> 00:42:56,921 >> GOOD MORNING, I'M JIM KOENIG. 1201 00:42:56,921 --> 00:43:01,892 I'LL BE MODERATING THE REST OF E 1202 00:43:01,892 --> 00:43:02,059 DAY. 1203 00:43:02,059 --> 00:43:03,694 THANK YOU TO CAYDANCE FOR 1204 00:43:03,694 --> 00:43:06,497 SHARING HER EXPERIENCES AS A 1205 00:43:06,497 --> 00:43:07,531 PERSON WITH CEREBRAL PALSY AND 1206 00:43:07,531 --> 00:43:10,501 AS A SUBJECT IN AN NIH-FUNDED 1207 00:43:10,501 --> 00:43:12,369 CLINICAL RESEARCH EFFORT. 1208 00:43:12,369 --> 00:43:14,405 HER PERSPECTIVESES ARE VERY 1209 00:43:14,405 --> 00:43:15,673 IMPORTANT IN HELPING TO FRAME 1210 00:43:15,673 --> 00:43:19,110 THE CRITICAL ISSUES FACING 1211 00:43:19,110 --> 00:43:20,077 PERSONS WITH CEREBRAL PALSY. 1212 00:43:20,077 --> 00:43:22,213 ALSO I WANT TO THANK RACHEL 1213 00:43:22,213 --> 00:43:25,583 BYRNE FOR SHARING THE 1214 00:43:25,583 --> 00:43:27,551 INFORMATION ABOUT CPS EARLY 1215 00:43:27,551 --> 00:43:29,954 DETECTION NETWORK AND THIS IS A 1216 00:43:29,954 --> 00:43:33,657 CRITICALLY IMPORTANT ELEMENT IN 1217 00:43:33,657 --> 00:43:38,129 UNDERSTANDING AND GETTING MORE 1218 00:43:38,129 --> 00:43:38,996 CP IMPLEMENTATION RESEARCH 1219 00:43:38,996 --> 00:43:40,764 ACTUAL LOW DONE AND I WANT TO 1220 00:43:40,764 --> 00:43:42,299 THANK HER FOR SHARING THE 1221 00:43:42,299 --> 00:43:45,603 EFFORTS THAT CPF IS UNDERTAKING. 1222 00:43:45,603 --> 00:43:48,005 AS YOU HEARD, THE PURPOSE OF THE 1223 00:43:48,005 --> 00:43:51,308 WORKSHOP IS TO PROVIDE AN UPDATE 1224 00:43:51,308 --> 00:43:53,043 ON CURRENT RESEARCH IN CEREBRAL 1225 00:43:53,043 --> 00:43:55,246 PALSY AND HOW IT RELATES TO THE 1226 00:43:55,246 --> 00:43:57,348 STRATEGIC PLAN FOR CP RESEARCH 1227 00:43:57,348 --> 00:44:00,584 THAT WAS PUBLISHED IN 2017. 1228 00:44:00,584 --> 00:44:02,086 WE WILL CONTINUE THIS MORNING BY 1229 00:44:02,086 --> 00:44:05,256 HEARING A SERIES OF SIX 1230 00:44:05,256 --> 00:44:06,190 PRESENTATIONS THAT WILL SPEAK TO 1231 00:44:06,190 --> 00:44:07,725 THE PROGRESS OF RESEARCH IN 1232 00:44:07,725 --> 00:44:09,627 BASIC AND TRANSLATIONAL 1233 00:44:09,627 --> 00:44:09,894 RESEARCH. 1234 00:44:09,894 --> 00:44:12,363 I WANT TO REMIND YOU, THAT THERE 1235 00:44:12,363 --> 00:44:15,566 ARE FORMING THEMES IN THE 1236 00:44:15,566 --> 00:44:17,134 STRATEGIC PLAN FOR BASIC AND 1237 00:44:17,134 --> 00:44:18,702 TRANSLATIONAL RESEARCH AND THOSE 1238 00:44:18,702 --> 00:44:20,704 THEMES ARE TO ENHANCE 1239 00:44:20,704 --> 00:44:22,373 UNDERSTANDING OF THE FUNDAMENTAL 1240 00:44:22,373 --> 00:44:24,542 MECHANISMS OF THE DEVELOPING 1241 00:44:24,542 --> 00:44:26,911 BRAIN, SPINE AND MUSCLE ACCESS 1242 00:44:26,911 --> 00:44:29,647 SO INTEGRATE STATE OF THE ART 1243 00:44:29,647 --> 00:44:31,415 NEUROIMAGING, TO CLARIFY 1244 00:44:31,415 --> 00:44:35,519 MECHANISMS AND ESTABLISH BOY 1245 00:44:35,519 --> 00:44:36,720 BIOMARKERS AND UNDERSTAND AND 1246 00:44:36,720 --> 00:44:38,489 UTILIZE NEURO PLASTICITY. 1247 00:44:38,489 --> 00:44:40,024 THE PRESENTATIONS THAT WORE 1248 00:44:40,024 --> 00:44:41,825 GOING TO HEAR OVER THE NEXT TWO 1249 00:44:41,825 --> 00:44:45,896 DAYS, ACTUALLY REPRESENTS 1250 00:44:45,896 --> 00:44:47,798 SNAPSHOTS OF SOME VERY EXCITING 1251 00:44:47,798 --> 00:44:49,133 SCIENTIFIC ADVANCES THAT HAVE 1252 00:44:49,133 --> 00:44:51,302 BEEN MADE SINCE 2017. 1253 00:44:51,302 --> 00:44:53,904 SO, TO START WITH THIS MORNING, 1254 00:44:53,904 --> 00:44:56,607 WE'LL BE HEARING A PRESENTATION 1255 00:44:56,607 --> 00:45:05,849 BY Dr. BHOOMA AVARMUTHAN AND 1256 00:45:05,849 --> 00:45:12,856 HER PRESENTATIONS IS TITLED 1257 00:45:12,856 --> 00:45:14,491 NEONATAL BRAIN INJURY IMPACTS ON 1258 00:45:14,491 --> 00:45:14,992 DEVELOPMENT. 1259 00:45:14,992 --> 00:45:19,630 AND A TALK BY MICHAEL KRUER. 1260 00:45:19,630 --> 00:45:21,765 HE IS AN ASSOCIATE PROFESSOR AT 1261 00:45:21,765 --> 00:45:24,235 UNIVERSITY OF ARIZONA SCHOOL OF 1262 00:45:24,235 --> 00:45:27,671 MEDICINE IN PHOENIX. 1263 00:45:27,671 --> 00:45:29,206 HIS TITLE WILL BE GENOMIC 1264 00:45:29,206 --> 00:45:31,542 INSIGHTS INTO THE NEUROBIOLOGY 1265 00:45:31,542 --> 00:45:32,610 OF CEREBRAL PALSY. 1266 00:45:32,610 --> 00:45:37,181 AND OUR NEXT SPEAKER WILL BE 1267 00:45:37,181 --> 00:45:38,716 Dr. NEHAL PARIKH. 1268 00:45:38,716 --> 00:45:41,986 A PROFESSOR AND DIRECTOR OF THE 1269 00:45:41,986 --> 00:45:44,355 CENTER FOR THE PREVENTION AND 1270 00:45:44,355 --> 00:45:46,757 NEURO DEVELOPMENTAL DISORDERS AT 1271 00:45:46,757 --> 00:45:47,791 CINCINNATI CHILDREN'S HOSPITAL. 1272 00:45:47,791 --> 00:45:50,894 HIS PRESENTATION IS TITLED EARLY 1273 00:45:50,894 --> 00:45:54,431 DIAGNOSIS OF PERINATAL BRAIN 1274 00:45:54,431 --> 00:45:56,667 INJURY DELAYED BRAIN DEVELOPMENT 1275 00:45:56,667 --> 00:45:57,401 AND CEREBRAL PALSY. 1276 00:45:57,401 --> 00:45:58,936 I'M SURE THESE PRESENTATIONS 1277 00:45:58,936 --> 00:46:00,604 WILL STIMULATE MANY QUESTIONS 1278 00:46:00,604 --> 00:46:02,806 AND I WILL WANT TO REMIND YOU TO 1279 00:46:02,806 --> 00:46:04,541 TYPE YOUR QUESTIONS UNDER THE 1280 00:46:04,541 --> 00:46:06,744 Q&A TAB AT THE BOTTOM OF THE 1281 00:46:06,744 --> 00:46:07,077 SCREEN. 1282 00:46:07,077 --> 00:46:09,346 IF YOU ARE WATCHING ON THE NIH 1283 00:46:09,346 --> 00:46:11,749 VIDEO CAST, PLEASE TYPE YOUR 1284 00:46:11,749 --> 00:46:13,684 QUESTIONS INTO THE LIVE FEEDBACK 1285 00:46:13,684 --> 00:46:14,251 BUTTON. 1286 00:46:14,251 --> 00:46:15,653 THE SPEAKERS WILL ANSWER YOUR 1287 00:46:15,653 --> 00:46:17,454 QUESTIONS DURING THE DISCUSSION 1288 00:46:17,454 --> 00:46:17,688 PERIOD. 1289 00:46:17,688 --> 00:46:19,690 SO WITH THAT, LET'S GO AHEAD AND 1290 00:46:19,690 --> 00:46:26,397 GET STARTED. 1291 00:46:26,397 --> 00:46:29,733 >> HI, MY NAME BHOOMA AND I'M AN 1292 00:46:29,733 --> 00:46:32,002 ASSISTANT PROFESSOR OF NEUROLOGY 1293 00:46:32,002 --> 00:46:34,371 IN ST. LOUIS MISSOURI AND I'VE 1294 00:46:34,371 --> 00:46:35,873 BEEN ASKED TO TALK ABOUT OUR 1295 00:46:35,873 --> 00:46:38,709 WORK ON NEONATAL BRAIN INJURY 1296 00:46:38,709 --> 00:46:40,010 IMPACTS ON DEVELOPMENT. 1297 00:46:40,010 --> 00:46:42,179 I HAVE NO RELEVANT DISCLOSURES 1298 00:46:42,179 --> 00:46:45,783 BUT MY COMPREHENSIVE DISCLOSURES 1299 00:46:45,783 --> 00:46:46,383 ARE HERE. 1300 00:46:46,383 --> 00:46:47,685 WE'RE HERE TO TALK ABOUT CP 1301 00:46:47,685 --> 00:46:49,787 WHICH IS A LIFELONG MOTOR 1302 00:46:49,787 --> 00:46:51,088 DISABILITY DUE TO A NON 1303 00:46:51,088 --> 00:46:52,723 PROGRESSIVE DISTURBANCE IN THE 1304 00:46:52,723 --> 00:46:54,158 DEVELOPING FETAL OR INFANT BRAIN 1305 00:46:54,158 --> 00:46:56,160 AND WHEN I THINK ABOUT MODELING 1306 00:46:56,160 --> 00:46:58,762 CP OR MODELING NEONATAL BRAIN 1307 00:46:58,762 --> 00:46:59,930 INJURY IN MICE, I THINK ABOUT 1308 00:46:59,930 --> 00:47:02,132 THESE ASPECTS OF THE DEFINITION, 1309 00:47:02,132 --> 00:47:06,036 WHAT DO WE MEAN WHEN WE SAY 1310 00:47:06,036 --> 00:47:06,737 NON-PROGRESSIVE DISTURB ANKERS 1311 00:47:06,737 --> 00:47:08,405 FETAL OR INFANT BRAIN AND HOW DO 1312 00:47:08,405 --> 00:47:11,041 WE CHARACTER USE THE MOTOR 1313 00:47:11,041 --> 00:47:12,476 MANIFESTATIONS IN THE MODELS 1314 00:47:12,476 --> 00:47:13,510 THAT WE CREATE? 1315 00:47:13,510 --> 00:47:15,346 AND WHEN I THINK ABOUT THIS 1316 00:47:15,346 --> 00:47:17,181 TITLE, AND THIS IS QUITE A BROAD 1317 00:47:17,181 --> 00:47:19,883 TITLE, SO I'M GOING TO TELL YOU 1318 00:47:19,883 --> 00:47:23,187 HOW I CONCEPTUALIZE THIS IN OUR 1319 00:47:23,187 --> 00:47:25,089 LAB, WHEN YOU THINK ABOUT WHAT 1320 00:47:25,089 --> 00:47:26,724 MEET OWE NATAL MEANS, THERE ARE 1321 00:47:26,724 --> 00:47:28,659 DEFINITIONS IN PEOPLE BUT TO 1322 00:47:28,659 --> 00:47:30,661 TRANSLATE THIS TO MICE IS AN 1323 00:47:30,661 --> 00:47:33,297 INTERESTING CONCEPT IS THAT IS 1324 00:47:33,297 --> 00:47:35,132 AN AREA OF CONTROVERSY. 1325 00:47:35,132 --> 00:47:36,667 THAT'S IMPORTANT TO DISCUSS AND 1326 00:47:36,667 --> 00:47:38,235 THINK ABOUT WHEN MODELING THIS. 1327 00:47:38,235 --> 00:47:40,104 WHEN WE TALK ABOUT BRAIN INJURY, 1328 00:47:40,104 --> 00:47:40,838 WHAT DO WE MEAN? 1329 00:47:40,838 --> 00:47:42,473 THERE ARE MULTIPLE DIFFERENT 1330 00:47:42,473 --> 00:47:42,840 TYPES. 1331 00:47:42,840 --> 00:47:44,608 ARE WE TALKING ABOUT FOCAL, 1332 00:47:44,608 --> 00:47:45,542 GLOBAL, SYSTEMIC? 1333 00:47:45,542 --> 00:47:50,347 AND THEN WHEN WE TALK ABOUT 1334 00:47:50,347 --> 00:47:52,583 DEVELOPMENT AND THERE ARE MANY 1335 00:47:52,583 --> 00:47:53,717 WAYS TO THINK ABOUT IT. 1336 00:47:53,717 --> 00:47:55,652 WE CAN THICK ABOUT IT IN A MICRO 1337 00:47:55,652 --> 00:47:55,853 SENSE. 1338 00:47:55,853 --> 00:47:57,187 WHAT IS HAPPENING TO BRAIN 1339 00:47:57,187 --> 00:47:58,255 STRUCTURE, WHAT IS HAPPENING ON 1340 00:47:58,255 --> 00:48:01,258 A MOLECULAR OR PATHOLOGIC LEVEL 1341 00:48:01,258 --> 00:48:02,426 BUT WE CAN ALSO THINK ABOUT IT 1342 00:48:02,426 --> 00:48:04,128 IN THE CONTEXT OF THE DEFINITION 1343 00:48:04,128 --> 00:48:06,697 OF CP, WHAT DO WE MEAN BY MOTOR 1344 00:48:06,697 --> 00:48:09,266 DEVELOPMENT, AND HOW DO WE 1345 00:48:09,266 --> 00:48:10,234 CHARACTERIZE THAT TO MAKE SURE 1346 00:48:10,234 --> 00:48:12,703 THAT THE MODELS WE DEVELOP ARE 1347 00:48:12,703 --> 00:48:14,104 CLINICALLY RELEVANT AND ARE 1348 00:48:14,104 --> 00:48:16,907 ALLOWING US TO ASK CLINICALLY 1349 00:48:16,907 --> 00:48:17,775 RELEVANT QUESTIONS. 1350 00:48:17,775 --> 00:48:21,311 IN OUR LAB, WE FOCUS ON HOW WE 1351 00:48:21,311 --> 00:48:22,946 CHARACTERIZE THE CLINICALLY 1352 00:48:22,946 --> 00:48:25,349 RELEVANT MOOD OR MAN MESSTATIONS 1353 00:48:25,349 --> 00:48:28,318 OF MODEL OF NEONATAL BRAIN 1354 00:48:28,318 --> 00:48:28,752 INJURIES. 1355 00:48:28,752 --> 00:48:30,454 THINKING ABOUT THE NEONATAL 1356 00:48:30,454 --> 00:48:31,388 ASPECT AND THIS IS SOMETHING 1357 00:48:31,388 --> 00:48:34,024 THAT MANY OF US IN THE ZOOM ROOM 1358 00:48:34,024 --> 00:48:40,631 RIGHT NOW FACE, MOUSE 1359 00:48:40,631 --> 00:48:41,932 GESTATIONAL TIMELINE IS VERY 1360 00:48:41,932 --> 00:48:43,834 DIFFERENT FROM THE HUMAN 1361 00:48:43,834 --> 00:48:45,469 GESTATIONAL TIMELINE AND WE TEND 1362 00:48:45,469 --> 00:48:47,037 TO THINK, BASED ON A FEW 1363 00:48:47,037 --> 00:48:51,141 MARKERS, BRAIN SIZE, DEGREE OF 1364 00:48:51,141 --> 00:48:53,243 MYELINATION THAT MOUSE POST 1365 00:48:53,243 --> 00:48:55,579 NATAL DAY 10, IS THE 1366 00:48:55,579 --> 00:48:58,315 APPROXIMATION FOR HUMAN TERM 1367 00:48:58,315 --> 00:48:58,649 GESTATION. 1368 00:48:58,649 --> 00:49:01,718 WE CALL THAT TERM EQUIVALENT 1369 00:49:01,718 --> 00:49:02,453 GESTATION IN MICE. 1370 00:49:02,453 --> 00:49:04,254 SO THAT REALLY BEGS TO QUESTION 1371 00:49:04,254 --> 00:49:08,225 WHAT DO WE MEAN BY PRO TERM OR 1372 00:49:08,225 --> 00:49:09,293 PREMATURE IN MICE BECAUSE WE 1373 00:49:09,293 --> 00:49:12,296 KNOW THAT MICE BORN AT MOUSE DAY 1374 00:49:12,296 --> 00:49:13,831 ZERO, THAT IS NOT PRE TERM FOR 1375 00:49:13,831 --> 00:49:14,164 THEM. 1376 00:49:14,164 --> 00:49:15,699 EVEN THOUGH THE BRAIN 1377 00:49:15,699 --> 00:49:16,867 DEVELOPMENT STAGE IS PRE TERM 1378 00:49:16,867 --> 00:49:21,538 WHEN YOU THINK ABOUT IT IN 1379 00:49:21,538 --> 00:49:23,407 HUMANS. 1380 00:49:23,407 --> 00:49:27,678 SO, IF WE COMPOUND A MOUSE POST 1381 00:49:27,678 --> 00:49:30,914 NATAL DAY 4, IS THAT THE BEST 1382 00:49:30,914 --> 00:49:32,983 APPROXIMATION OF PRO MATURITY 1383 00:49:32,983 --> 00:49:35,886 AND BRAIN INJURY THAT WE SEE 1384 00:49:35,886 --> 00:49:36,520 CLINICALLY? 1385 00:49:36,520 --> 00:49:39,756 SHOULD WE ALSO FOCUS ON TRYING 1386 00:49:39,756 --> 00:49:41,658 TO DEVELOP TRUE PRE-TERM BIRTH 1387 00:49:41,658 --> 00:49:43,660 MODELS IN MICE AND WHAT ARE THE 1388 00:49:43,660 --> 00:49:44,528 MANIFESTATIONS OF INJURIES THAT 1389 00:49:44,528 --> 00:49:45,629 WE SEE THERE? 1390 00:49:45,629 --> 00:49:47,030 THIS IS PARTICULARLY IMPORTANT 1391 00:49:47,030 --> 00:49:52,336 WHEN WE THINK ABOUT THE CP AND 1392 00:49:52,336 --> 00:50:01,445 WE KNOW IT'S HETERONENOUS AND 1393 00:50:01,445 --> 00:50:02,913 PEOPLE WHO HAVE AN ACQUIRED 1394 00:50:02,913 --> 00:50:03,547 BRAIN INJURY. 1395 00:50:03,547 --> 00:50:06,250 THE TYPE OF BRAIN INJURY YOU 1396 00:50:06,250 --> 00:50:07,818 HAVE REALLY DIFFERS DEPENDING ON 1397 00:50:07,818 --> 00:50:12,022 WHO YOU ARE AND WH WHERE YOU LID 1398 00:50:12,022 --> 00:50:15,659 THIS IS PUT INTO STRIKING RELIEF 1399 00:50:15,659 --> 00:50:17,394 WITH BEAUTIFUL EPIDEMIOLOGY DEEM 1400 00:50:17,394 --> 00:50:19,096 LOGIC STUDIES ACROSS THE GLOBE. 1401 00:50:19,096 --> 00:50:20,597 A LARGE PORTION OF PEOPLE WITH 1402 00:50:20,597 --> 00:50:22,933 CP ARE BORN PREMATURE AND HAVE 1403 00:50:22,933 --> 00:50:26,470 PREMATURE TEE ASSOCIATED BRAIN 1404 00:50:26,470 --> 00:50:27,871 INJURIES IN HIGH-INCOME 1405 00:50:27,871 --> 00:50:29,106 COUNTRIES LIKE IN THE COUNTRIES 1406 00:50:29,106 --> 00:50:31,074 IN NORTH AMERICA. 1407 00:50:31,074 --> 00:50:32,976 BUT, IF WE LOOK AT LOW AND 1408 00:50:32,976 --> 00:50:35,012 MIDDLE INCOME COUNTRIES AND THE 1409 00:50:35,012 --> 00:50:37,514 CP EPIDEMIOLOGY THERE, THE 1410 00:50:37,514 --> 00:50:38,582 PREPORTIONS SHIFT. 1411 00:50:38,582 --> 00:50:41,151 SEW FEWER, A SMALLER PERCENTAGE 1412 00:50:41,151 --> 00:50:43,754 ARE BORN PREMATURE IN BANGLADESH 1413 00:50:43,754 --> 00:50:50,227 AND SMALL NER GHAND AND IT 1414 00:50:50,227 --> 00:50:51,995 INCREASES SO WHEN WE THINK ABOUT 1415 00:50:51,995 --> 00:50:53,163 CP, IT'S IMPORTANT TO THINK 1416 00:50:53,163 --> 00:50:57,434 ABOUT ALL OF THESE IDEOLOGIES 1417 00:50:57,434 --> 00:50:58,468 AND NOT JUST ONE. 1418 00:50:58,468 --> 00:51:01,271 THIS WAS BROUGHT INTO -- THIS IS 1419 00:51:01,271 --> 00:51:04,708 A KEY POINT IN THIS BEAUTIFUL 1420 00:51:04,708 --> 00:51:06,710 PAPER THAT CELEBRATES 40 YEARS, 1421 00:51:06,710 --> 00:51:08,145 40 PLUS YEARS WE HAVE OF THE 1422 00:51:08,145 --> 00:51:11,882 CLASSIC AND REALLY GROUND 1423 00:51:11,882 --> 00:51:17,487 BREAKING VANNUCCI MODEL OF THE 1424 00:51:17,487 --> 00:51:18,922 MOUSE. 1425 00:51:18,922 --> 00:51:19,523 INTERESTINGLY, EPIDEMIOLOGY AT 1426 00:51:19,523 --> 00:51:22,092 THIS LEVEL OF SEVERE INSULT, 1427 00:51:22,092 --> 00:51:23,493 WHICH ESTABLISHED A LEVEL OF 1428 00:51:23,493 --> 00:51:25,028 VARIABILITY IN THIS MODEL, THIS 1429 00:51:25,028 --> 00:51:26,897 IS BEEN BOTH A BENEFIT AND A 1430 00:51:26,897 --> 00:51:28,332 CURSE TO MANY OF THE 1431 00:51:28,332 --> 00:51:29,833 INVESTIGATORS WHO HAVE USED IT. 1432 00:51:29,833 --> 00:51:31,969 AND WE SEE VARIABILITY ACROSS 1433 00:51:31,969 --> 00:51:34,738 MODELS IN NEONATAL BRAIN INJURY. 1434 00:51:34,738 --> 00:51:36,406 I CHOSE TO BELIEVE IN THE 1435 00:51:36,406 --> 00:51:37,708 BENEFIT OF THIS VARIABILITY. 1436 00:51:37,708 --> 00:51:39,476 BECAUSE I THINK IT'S REALLY 1437 00:51:39,476 --> 00:51:40,811 CLINICALLY RELEVANT. 1438 00:51:40,811 --> 00:51:47,551 CP IS HETEROGONOUS AND THE FEET 1439 00:51:47,551 --> 00:51:48,852 OWE TYPES ARE TOO. 1440 00:51:48,852 --> 00:51:50,621 SO, I THINK IT'S IMPORTANT TO 1441 00:51:50,621 --> 00:51:51,922 EMBRACE THE VARIABILITIES OF 1442 00:51:51,922 --> 00:51:53,790 THESE MODELS AND FOR A LONG 1443 00:51:53,790 --> 00:51:57,861 TIME, WE'VE BEEN STRUGGLING WITH 1444 00:51:57,861 --> 00:52:06,436 CONFORMITY AND WE'RE DOING THAT 1445 00:52:06,436 --> 00:52:13,377 IN A FEW WAYS, SO, WE'VE LOOKED 1446 00:52:13,377 --> 00:52:17,047 AT DIFFERENT MODELS THAT WE 1447 00:52:17,047 --> 00:52:18,482 THINK REPRESENT DIFFERENT TYPES 1448 00:52:18,482 --> 00:52:23,820 OF CPETIOLOGIES. 1449 00:52:23,820 --> 00:52:28,025 WE HAVE GLOBAL HYPOXIA-ISCMIA 1450 00:52:28,025 --> 00:52:31,728 AND WE HAVE A MODEL OF PREMATURE 1451 00:52:31,728 --> 00:52:34,698 BIRTH WHERE WE INDUCE THE DAMN 1452 00:52:34,698 --> 00:52:36,600 TO DELIVER ABOUT 24 HOURS EARLY 1453 00:52:36,600 --> 00:52:40,137 AND THESE ARE C50 SALMON BLOCK 1454 00:52:40,137 --> 00:52:41,938 SIX MICE SO INSTEAD OF 1455 00:52:41,938 --> 00:52:45,676 DELIVERING AT E19.5 THEY DELIVER 1456 00:52:45,676 --> 00:52:48,712 AT E18-5 SO THAT IS A MODEL OF 1457 00:52:48,712 --> 00:52:50,380 EXTREME PREMATURE BIRTH IF WE 1458 00:52:50,380 --> 00:52:53,083 THINK ABOUT IT FROM THE HUMAN 1459 00:52:53,083 --> 00:52:53,350 TIMELINE. 1460 00:52:53,350 --> 00:52:55,552 BUT IT'S ALSO MODEL OF TRUE 1461 00:52:55,552 --> 00:52:56,753 PREMATURE BIRTH FOR MICE ON 1462 00:52:56,753 --> 00:52:58,021 THEIR OWN TIMELINE. 1463 00:52:58,021 --> 00:52:59,823 SO WE'VE STARTED CHARACTERIZING 1464 00:52:59,823 --> 00:53:02,025 THAT MODEL AND THERE'S THE 1465 00:53:02,025 --> 00:53:05,328 CLASSIC VANNUCCI MODEL THAT IS 1466 00:53:05,328 --> 00:53:06,630 MOST ALIGNED WITH TERM STROKE 1467 00:53:06,630 --> 00:53:08,932 AND WE'RE WORKING WITH IVH 1468 00:53:08,932 --> 00:53:10,801 MODELS AND THESE LAST TWO MODELS 1469 00:53:10,801 --> 00:53:13,070 WE'RE WORKING WITH COLLABORATORS 1470 00:53:13,070 --> 00:53:14,104 AT WASHU. 1471 00:53:14,104 --> 00:53:16,406 I WANT TO IMPRESSES THAT WE FEEL 1472 00:53:16,406 --> 00:53:19,443 IT'S EXTREMELY IMPORTANT THOUGH 1473 00:53:19,443 --> 00:53:21,812 CHARACTERIZE MOTOR FUNCTION AND 1474 00:53:21,812 --> 00:53:25,982 STUDY THE PATHOLOGY OF CP AND 1475 00:53:25,982 --> 00:53:27,384 DEVELOPMENTAL INJURIES ACROSS A 1476 00:53:27,384 --> 00:53:29,519 WIDE VARIETY OF INSULTS AND WE 1477 00:53:29,519 --> 00:53:31,021 FEEL IT BEST ALLOWS US TO 1478 00:53:31,021 --> 00:53:32,322 UNDERSTAND THE SPECTRUM OF 1479 00:53:32,322 --> 00:53:33,857 CONCERNS AND CP. 1480 00:53:33,857 --> 00:53:35,992 WHEN WE THINK ABOUT MOTOR 1481 00:53:35,992 --> 00:53:36,893 DEVELOPMENT, THERE ARE A COUPLE 1482 00:53:36,893 --> 00:53:38,562 OF WAYS WE CAN THINK ABOUT THAT 1483 00:53:38,562 --> 00:53:39,162 TOO. 1484 00:53:39,162 --> 00:53:41,031 SO, WE CAN THINK ABOUT IT IN 1485 00:53:41,031 --> 00:53:43,934 TERMS OF FUNCTION, THINGS LIKE 1486 00:53:43,934 --> 00:53:45,802 OPEN FIELD, A WIDE ARRAY OF 1487 00:53:45,802 --> 00:53:47,304 STANDARD GAIN ANALYSIS METRICS 1488 00:53:47,304 --> 00:53:48,505 AND WE CAN ALSO THINK ABOUT IT 1489 00:53:48,505 --> 00:53:50,240 IN TERMS OF PHENOTYPE. 1490 00:53:50,240 --> 00:53:52,175 BASED ON OUR LABS' INTEREST WE 1491 00:53:52,175 --> 00:53:54,277 FOCUS ON ONE PHENOTYPE WHICH IS 1492 00:53:54,277 --> 00:53:56,747 DIS TONIA AND FOR THE REST OF 1493 00:53:56,747 --> 00:53:59,349 THE TALK, I'LL TALK ABOUT HOW WE 1494 00:53:59,349 --> 00:54:01,585 CHARACTERIZE DIS TONIA IN THESE 1495 00:54:01,585 --> 00:54:03,353 TOP TWO MODELS HERE THAT WE'VE 1496 00:54:03,353 --> 00:54:13,130 DEVELOPED IN THE LAB. 1497 00:54:13,130 --> 00:54:14,798 YOU CONTRACT MUSCLES YOU DON'T 1498 00:54:14,798 --> 00:54:15,966 WANT WHEN YOU MOVE A DIFFERENT 1499 00:54:15,966 --> 00:54:17,000 PART OF YOUR BODY. 1500 00:54:17,000 --> 00:54:19,202 AS I SAY THAT, YOU CAN PROBABLY 1501 00:54:19,202 --> 00:54:20,937 UNDERSTAND HOW FUNCTIONALLY 1502 00:54:20,937 --> 00:54:22,239 DOUGH BILL TATING DYSTONIA IS 1503 00:54:22,239 --> 00:54:23,774 AND IT'S A VERY COMMON PROBLEM 1504 00:54:23,774 --> 00:54:25,809 IN PEOPLE WITH CP. 1505 00:54:25,809 --> 00:54:27,711 IT IS CITED AS THE SECOND MOST 1506 00:54:27,711 --> 00:54:28,812 COMMON CAUSE OF PAIN IN PEOPLE 1507 00:54:28,812 --> 00:54:30,447 WITH CP. 1508 00:54:30,447 --> 00:54:31,782 IT'S ASSOCIATED WITH GREATER 1509 00:54:31,782 --> 00:54:33,984 GROSS MOTOR FUNCTIONAL 1510 00:54:33,984 --> 00:54:34,284 IMPAIRMENT. 1511 00:54:34,284 --> 00:54:35,752 IT IS PRETTY DIFFICULT TO TREAT 1512 00:54:35,752 --> 00:54:37,053 AND THAT'S BECAUSE TREATMENTS 1513 00:54:37,053 --> 00:54:39,089 TARGETED FOR DYSTONIA ARE 1514 00:54:39,089 --> 00:54:41,091 LIMITED AND ALSO THERE'S 1515 00:54:41,091 --> 00:54:42,959 EMERGING DATA THE EARLIER YOU 1516 00:54:42,959 --> 00:54:44,294 TREAT DYSTONIA THE BETTER. 1517 00:54:44,294 --> 00:54:47,330 BUT THERE'S A DELAY IN HOW OFTEN 1518 00:54:47,330 --> 00:54:48,865 WE'RE IDENTIFYING DYSTONIA IN 1519 00:54:48,865 --> 00:54:50,967 YOUNG CHILDREN, PRECLUDING THIS 1520 00:54:50,967 --> 00:54:52,502 POTENTIAL TREATMENT BENEFIT. 1521 00:54:52,502 --> 00:54:54,304 AND DESPITE THESE GAPS, DYSTONIA 1522 00:54:54,304 --> 00:54:55,338 IS COMMON. 1523 00:54:55,338 --> 00:54:57,908 SO, DYSTONIA IS THE MOST COMMON 1524 00:54:57,908 --> 00:54:59,576 FORM OF TONE IN 15% OF PEOPLE 1525 00:54:59,576 --> 00:55:02,312 WITH CP, AND IT'S THE MOST 1526 00:55:02,312 --> 00:55:03,146 PREDOMINANT FORM OF TONE. 1527 00:55:03,146 --> 00:55:04,948 BUT IT CAN BE PRESENT AND 1528 00:55:04,948 --> 00:55:08,018 SOMEWHERE UP TO 75% TO 80% OF 1529 00:55:08,018 --> 00:55:09,553 PEOPLE WITH CP AND JUST BY 1530 00:55:09,553 --> 00:55:10,554 UNDERSTANDING THE DEFINITION OF 1531 00:55:10,554 --> 00:55:12,689 IT, THE CHANCES OF IT BEING 1532 00:55:12,689 --> 00:55:13,990 FUNCTIONALLY LIMITING IN AWFUL 1533 00:55:13,990 --> 00:55:18,495 THESE PEOPLE, IS QUITE HIGH. 1534 00:55:18,495 --> 00:55:19,563 SO, THIS BEGS TO QUESTION, HOW 1535 00:55:19,563 --> 00:55:23,600 DO WE FOCUS ON H ON IT AND HOW E 1536 00:55:23,600 --> 00:55:24,868 DEVELOP TREATMENTS FOR DYSTONIA 1537 00:55:24,868 --> 00:55:27,370 AND HOW DO WE UNDERSTAND HOW 1538 00:55:27,370 --> 00:55:29,940 DYSTONIA DEVELOPS AFTER NEONATAL 1539 00:55:29,940 --> 00:55:31,041 BRAIN INJURY SO WE CAN BETTER 1540 00:55:31,041 --> 00:55:33,743 UNDERSTAND HOW TO TREAT IT WITH 1541 00:55:33,743 --> 00:55:35,212 PEOPLE WITH CP AND THIS IS OUR 1542 00:55:35,212 --> 00:55:35,979 MISSION IN THE LAB. 1543 00:55:35,979 --> 00:55:38,114 WE FIRST STARTED LOOKING AT 1544 00:55:38,114 --> 00:55:42,419 DYSTONIA IN OUR MODEL OF 1545 00:55:42,419 --> 00:55:45,388 FINANCIAL HIGH POXY HE IS 1546 00:55:45,388 --> 00:55:46,556 ESCHEMIA SO THESE ARE MICE THAT 1547 00:55:46,556 --> 00:55:50,126 ARE EXPOSED TO ROOM AIR AND THEN 1548 00:55:50,126 --> 00:55:52,395 HAVE THAT ROOM AIR DECREASED 1549 00:55:52,395 --> 00:56:02,873 OVER TIME AND THESE MICE GO 1550 00:56:04,107 --> 00:56:05,508 PULSE LESS AT ABOUT SIX MINUTES 1551 00:56:05,508 --> 00:56:08,478 AND THEN HAVE SOME MAINTAIN EKG 1552 00:56:08,478 --> 00:56:10,614 ACTIVITY SO THEY UNDERGO PULSE 1553 00:56:10,614 --> 00:56:11,915 LESS ARREST AROUND SIX MINUTES 1554 00:56:11,915 --> 00:56:13,083 AND MAINTAIN THAT FOR SIX 1555 00:56:13,083 --> 00:56:17,053 MINUTES THROUGH THE END OF THE 1556 00:56:17,053 --> 00:56:21,725 INSULT AND WE SEE SOME LIMITED 1557 00:56:21,725 --> 00:56:23,326 FUNCTIONAL IMPAIRMENT BASED ON 1558 00:56:23,326 --> 00:56:25,061 CLASSIC STUDIES IN THESE MICE. 1559 00:56:25,061 --> 00:56:28,698 SO, WE LOOKED AT SOME BASIC GATE 1560 00:56:28,698 --> 00:56:30,100 METRICS, STRIDE LENGTH, TRIED 1561 00:56:30,100 --> 00:56:30,700 DURATION AND SPEED. 1562 00:56:30,700 --> 00:56:34,104 YOU SEE THAT SPEED AND STRIDE 1563 00:56:34,104 --> 00:56:36,006 DURATION IS UNEFFECTED AND THE 1564 00:56:36,006 --> 00:56:38,375 BLUE IS HYPOXIA AND THESE ARE 1565 00:56:38,375 --> 00:56:40,810 MICE AT P28 AFTER INSULT OF P10. 1566 00:56:40,810 --> 00:56:42,712 YOU SEE THAT STRIDE LENGTH IS 1567 00:56:42,712 --> 00:56:44,247 SHORTER IN THESE MICE. 1568 00:56:44,247 --> 00:56:46,449 BUT THAT THE OTHER METRICS ARE 1569 00:56:46,449 --> 00:56:47,050 NOT DIFFERENT. 1570 00:56:47,050 --> 00:56:49,552 AND YOU ALSO SEE THAT THE ROT OR 1571 00:56:49,552 --> 00:56:50,754 FOLLOW IS NOT DIFFERENT IN THESE 1572 00:56:50,754 --> 00:56:53,590 MICE SO VERY LIMITED IN TERMS OF 1573 00:56:53,590 --> 00:56:56,559 FUNCTION IMPACT BUT DETECTABLE 1574 00:56:56,559 --> 00:56:57,861 FUNCTIONAL IMPACT. 1575 00:56:57,861 --> 00:57:00,196 THIS IS SOMETHING THAT IS 1576 00:57:00,196 --> 00:57:01,865 VALUABLE TO NOTE BUT DOES NOT 1577 00:57:01,865 --> 00:57:03,233 NECESSARILY LIMIT THE UTILITY OF 1578 00:57:03,233 --> 00:57:06,303 THE MODEL TO STUDY PHENOTYPES. 1579 00:57:06,303 --> 00:57:07,737 AND I'LL TALK ABOUT HOW WE DO 1580 00:57:07,737 --> 00:57:10,707 THAT SPECIFICALLY FOR DYSTONIA. 1581 00:57:10,707 --> 00:57:12,676 WE HAVE LOOKED AT EMG IN A 1582 00:57:12,676 --> 00:57:15,078 COUPLE OF DIFFERENT WAYS AS 1583 00:57:15,078 --> 00:57:19,849 POTENTIAL ELECTRIC PHYSICAL OWE 1584 00:57:19,849 --> 00:57:21,251 LOGICAL AND A MOUSE RUNNING WITH 1585 00:57:21,251 --> 00:57:25,055 AN IMPLANTED EMG ARRAY IN BOTH 1586 00:57:25,055 --> 00:57:29,426 THE GAS STOP AND THE INTERIOR 1587 00:57:29,426 --> 00:57:32,963 BILATERALLY SO THE CALVES AND 1588 00:57:32,963 --> 00:57:33,663 THE SHIN MUSCLE. 1589 00:57:33,663 --> 00:57:35,532 YOU SEE IN THE MOUSE THESE 1590 00:57:35,532 --> 00:57:37,233 MUSCLES CONTRACT AS THEY SHOULD 1591 00:57:37,233 --> 00:57:39,703 SO THEY'RE MICE THAT HAVE NOT 1592 00:57:39,703 --> 00:57:40,937 UNDERGONE HYPOXIA. 1593 00:57:40,937 --> 00:57:42,605 THE CON TRACTION ALTERNATE. 1594 00:57:42,605 --> 00:57:43,640 YOU SHOULDN'T HAVE YOUR SHINS 1595 00:57:43,640 --> 00:57:45,342 AND THE MUSCLE ON YOUR SHIN AND 1596 00:57:45,342 --> 00:57:48,678 THE MUSCLE IN YOUR CALF CONTRACT 1597 00:57:48,678 --> 00:57:49,245 AT THE SAME TIME. 1598 00:57:49,245 --> 00:57:50,747 THEY SHOULD ALTERNATE. 1599 00:57:50,747 --> 00:57:54,417 IN THE MICE AFTER HYPOXIA 1600 00:57:54,417 --> 00:57:54,951 THERE'S OFFER LAP. 1601 00:57:54,951 --> 00:57:57,854 IF WE DO A TIME TRIGGER AVERAGE 1602 00:57:57,854 --> 00:58:00,690 OF THESE SIGNALS OR ACROSS, YOU 1603 00:58:00,690 --> 00:58:03,226 CAN SEE THAT AT ZERO LAG BETWEEN 1604 00:58:03,226 --> 00:58:04,961 THESE SIGNALS, THAT'S THE ZERO 1605 00:58:04,961 --> 00:58:07,197 HERE, THAT THE MICE AFTER 1606 00:58:07,197 --> 00:58:09,132 HYPOXIA HAVE A SLIGHTLY HIGHER 1607 00:58:09,132 --> 00:58:10,433 AMP ATTITUDE MEANING THERE'S CO 1608 00:58:10,433 --> 00:58:12,469 CON TRACTION HERE AND THESE 1609 00:58:12,469 --> 00:58:14,137 HIGHER AMP ATTITUDES, THIS 1610 00:58:14,137 --> 00:58:15,672 VOLUNTEERING MOVEMENT TRIGGERED 1611 00:58:15,672 --> 00:58:18,641 OVERFLOW ACTIVATION OF THESE 1612 00:58:18,641 --> 00:58:20,977 MUSCLE, ARE BY DEFINITION A 1613 00:58:20,977 --> 00:58:27,450 POTENTIAL INDICATE OF DYSTONIA 1614 00:58:27,450 --> 00:58:29,252 AND WE DON'T SEE A DIFFERENT 1615 00:58:29,252 --> 00:58:31,121 BETWEEN THE SHAM EXPOSED AND THE 1616 00:58:31,121 --> 00:58:33,023 HYPOXIA EXPOSED MICE. 1617 00:58:33,023 --> 00:58:34,624 THIS IS 18 DAYS AFTER THE 1618 00:58:34,624 --> 00:58:45,101 INITIAL HIGH POX' EXPOSURE. 1619 00:58:46,102 --> 00:58:48,071 WOULD SEE THIS IN THE MODEL OF 1620 00:58:48,071 --> 00:58:49,472 THE BRAIN INJURY WE STUDY. 1621 00:58:49,472 --> 00:58:51,474 THERE'S A DELAY IN ONSET OF 1622 00:58:51,474 --> 00:58:51,941 DYSTONIA. 1623 00:58:51,941 --> 00:58:56,379 AND THIS DOES RECAPITULATE THE 1624 00:58:56,379 --> 00:58:57,680 CLINICAL DELAY WE SEE. 1625 00:58:57,680 --> 00:58:59,315 MONTHS AND SOMETIMES YEARS AFTER 1626 00:58:59,315 --> 00:59:00,850 THE BRAIN INJURY BEFORE DYSTONIA 1627 00:59:00,850 --> 00:59:02,419 DEVELOPS AND WE SEE IT IN THESE 1628 00:59:02,419 --> 00:59:03,086 MODELS AS WELL. 1629 00:59:03,086 --> 00:59:05,121 WHEN WE LOOK AT THE HYSTE 1630 00:59:05,121 --> 00:59:06,890 PATHOLOGY IN THESE MODELS WE 1631 00:59:06,890 --> 00:59:10,093 FOCUS ON STRIATAL INTER NEURONS 1632 00:59:10,093 --> 00:59:11,594 AND THE REASON IS BECAUSE OF 1633 00:59:11,594 --> 00:59:12,796 THEIR CLEAR IMPORTANCE IN 1634 00:59:12,796 --> 00:59:13,963 REGULATING MOVEMENT AND ALSO 1635 00:59:13,963 --> 00:59:16,066 BECAUSE AS A LAB, WE'RE 1636 00:59:16,066 --> 00:59:16,866 PARTICULARLY INTERESTED IN 1637 00:59:16,866 --> 00:59:19,002 NEURONS AND I'LL GET INTO WHY 1638 00:59:19,002 --> 00:59:19,569 SHORTLY. 1639 00:59:19,569 --> 00:59:22,405 WE SEE THAT IN THE HIGH POX' 1640 00:59:22,405 --> 00:59:23,673 EXPOSED ANIMALS THERE'S A 1641 00:59:23,673 --> 00:59:25,008 INCREASE IN THE NEURONS AND YOU 1642 00:59:25,008 --> 00:59:28,878 CAN SEE THAT JUST VISUALLY IN 1643 00:59:28,878 --> 00:59:29,946 THESE SLICES. 1644 00:59:29,946 --> 00:59:31,081 THAT'S A SIGNIFICANT DIFFERENCE 1645 00:59:31,081 --> 00:59:32,182 BETWEEN THESE GROUPS. 1646 00:59:32,182 --> 00:59:34,984 BUT IF WE LOOK AT ANOTHER TYPE 1647 00:59:34,984 --> 00:59:38,254 OF STRIATAL INTER NEURONS, YOU 1648 00:59:38,254 --> 00:59:40,290 SEE THAT THAT DIFFERENCE IS NOT 1649 00:59:40,290 --> 00:59:43,193 THERE SO THIS SEEMS TO BE 1650 00:59:43,193 --> 00:59:45,562 SPECIFIC TO HYPOXIA AND 1651 00:59:45,562 --> 00:59:47,097 SPECIFICALLY IN THE MODEL. 1652 00:59:47,097 --> 00:59:49,132 AND THAT'S INTERESTING TO US 1653 00:59:49,132 --> 00:59:52,769 BECAUSE WE KNOW IN OTHER MODELS 1654 00:59:52,769 --> 00:59:56,606 GENETIC DYSTONIA THERE'S 1655 00:59:56,606 --> 00:59:58,041 ABNORMAL INTER NEURONS SO WE'RE 1656 00:59:58,041 --> 01:00:00,110 GOING ON TO EXPLOIT THIS IN THE 1657 01:00:00,110 --> 01:00:04,180 LAB USING THIS RELATIVELY SUBTLE 1658 01:00:04,180 --> 01:00:05,381 PATHOLOGIC FINDING AND I WILL 1659 01:00:05,381 --> 01:00:06,916 NOTE THAT THERE'S NOT A 1660 01:00:06,916 --> 01:00:08,651 SIGNIFICANT DIFFERENCE IN ROY 1661 01:00:08,651 --> 01:00:12,622 SIZE AND THE ENGLI REGION SIZE O 1662 01:00:12,622 --> 01:00:14,090 CYSTIC LESIONS IN THIS MODEL AND 1663 01:00:14,090 --> 01:00:16,793 IT'S REALLY A SPECIFIC TARGETED 1664 01:00:16,793 --> 01:00:18,528 NEURON NUMBER OF DIFFERENCE AND 1665 01:00:18,528 --> 01:00:20,763 THAT REALLY ALLOWS US TO 1666 01:00:20,763 --> 01:00:24,868 MANIPULATE THE CIRCUITRY ALMOST 1667 01:00:24,868 --> 01:00:28,638 TO SOME DEGREE UNBOTHERED BY 1668 01:00:28,638 --> 01:00:30,140 SIGNIFICANT TISSUE INJURY THAT 1669 01:00:30,140 --> 01:00:31,641 MIGHT OTHERWISE EFFECT OUR 1670 01:00:31,641 --> 01:00:33,910 RESULTS SO WE'RE USING 1671 01:00:33,910 --> 01:00:35,545 TECHNIQUES RIGHT NOW TO 1672 01:00:35,545 --> 01:00:36,746 CHRONICALLY MANIPULATE INTER 1673 01:00:36,746 --> 01:00:38,748 NEURONS AND THIS AND OTHER 1674 01:00:38,748 --> 01:00:40,917 MODELS OF BRAIN INJURY TO SEE IF 1675 01:00:40,917 --> 01:00:42,652 THAT HELPS TURN UP OR TURN DOWN 1676 01:00:42,652 --> 01:00:44,554 THE DYSTONIA MARKERS THAT WE SEE 1677 01:00:44,554 --> 01:00:45,855 IN THESE ANIMALS. 1678 01:00:45,855 --> 01:00:48,458 AND I WANT TO TALK A LITTLE BIT 1679 01:00:48,458 --> 01:00:50,326 ABOUT HOW DYSTONIA IS 1680 01:00:50,326 --> 01:00:51,161 CHARACTERIZED IN MICE. 1681 01:00:51,161 --> 01:00:53,396 I SHOWED YOU THIS EMG 1682 01:00:53,396 --> 01:00:56,733 CHARACTERIZATION BUT DYSTONIA IS 1683 01:00:56,733 --> 01:00:57,967 NOTED TO BE CLASPING AND IT'S 1684 01:00:57,967 --> 01:01:00,537 DONE THAT SORT OF CLASPING IS 1685 01:01:00,537 --> 01:01:02,205 CHARACTERIZED IN THIS SPECIFIC 1686 01:01:02,205 --> 01:01:05,408 TASK, THIS TALE SUSPENSION TASK 1687 01:01:05,408 --> 01:01:07,043 WHERE MICE ARE FORCED TO 1688 01:01:07,043 --> 01:01:11,314 MAINTAIN A CERTAIN POSTURE AND 1689 01:01:11,314 --> 01:01:13,550 THEY END UP BEHIND LIMBS YOU CAN 1690 01:01:13,550 --> 01:01:16,619 SEE IN THIS GENETIC MODEL OF 1691 01:01:16,619 --> 01:01:17,520 DYSTONIA. 1692 01:01:17,520 --> 01:01:19,355 DYT1 WITH PICTURES FOR THIS 1693 01:01:19,355 --> 01:01:23,193 MODEL TAKEN FROM SAM AND BILL'S 1694 01:01:23,193 --> 01:01:24,727 LAB AT UT SOUTHWESTERN. 1695 01:01:24,727 --> 01:01:27,830 THE ISSUES WITH CLASPING HAS 1696 01:01:27,830 --> 01:01:30,300 BEEN LONG KNOWN TO THE FIELD. 1697 01:01:30,300 --> 01:01:31,801 IT'S ALL OR NOTHING THAT DOESN'T 1698 01:01:31,801 --> 01:01:33,937 ALLOW FOR A NUANCE DETECTION OF 1699 01:01:33,937 --> 01:01:35,738 DYSTONIA WITHIN A MOUSE. 1700 01:01:35,738 --> 01:01:38,241 OTHER THAN HOW OFTEN OR HOW MUCH 1701 01:01:38,241 --> 01:01:38,841 THEY CLASP. 1702 01:01:38,841 --> 01:01:40,843 THE OTHER IS THAT MANY GENETIC 1703 01:01:40,843 --> 01:01:43,913 MODEL OF DYSTONIA THAT 1704 01:01:43,913 --> 01:01:45,448 RECAPITULATE THE CLINICAL 1705 01:01:45,448 --> 01:01:46,516 MUTATIONS DON'T CLASP. 1706 01:01:46,516 --> 01:01:49,586 IT'S POSSIBLE THIS MAY BE ONE 1707 01:01:49,586 --> 01:01:52,755 MANIFESTATION OF DYSTONIA IN 1708 01:01:52,755 --> 01:01:53,022 MICE. 1709 01:01:53,022 --> 01:01:56,826 BUT A RANGE OF MILDER DYSTONIA 1710 01:01:56,826 --> 01:01:58,094 PHENOTYPES MAY NOT BE CAPTURED 1711 01:01:58,094 --> 01:02:00,964 BY LOOKING AT JUST CLASPING 1712 01:02:00,964 --> 01:02:01,364 ALONE. 1713 01:02:01,364 --> 01:02:02,732 AND PERHAPS FOR ME, AS A 1714 01:02:02,732 --> 01:02:04,334 PHYSICIAN SCIENTIST, THAT CURES 1715 01:02:04,334 --> 01:02:06,369 FOR PEOPLE WITH CP, MANY OF WHOM 1716 01:02:06,369 --> 01:02:07,904 DOES HAVE DYSTONIA, THE MOST 1717 01:02:07,904 --> 01:02:09,439 IMPORTANT THING TO ME IS THAT 1718 01:02:09,439 --> 01:02:10,240 PEOPLE DON'T CLASP. 1719 01:02:10,240 --> 01:02:12,242 YOU DON'T SEE A PERSON WITH CP 1720 01:02:12,242 --> 01:02:15,545 AND DYSTONIA COME IN AND DO THIS 1721 01:02:15,545 --> 01:02:17,880 AS AN EXAMPLE OF THEIR DIS TONE 1722 01:02:17,880 --> 01:02:18,982 Y THINKING ABOUT THE CLINICALLY 1723 01:02:18,982 --> 01:02:22,151 RELEVANT MARKERS OF DYSTONIA IN 1724 01:02:22,151 --> 01:02:24,153 MICE BECAME A REAL IMPORTANT 1725 01:02:24,153 --> 01:02:25,822 ISSUE FOR US IN THE LAB. 1726 01:02:25,822 --> 01:02:27,724 THE WAY WE TRIED TO DETERMINE 1727 01:02:27,724 --> 01:02:29,492 THAT WAS GOING BACK TO THE 1728 01:02:29,492 --> 01:02:30,927 CLINIC AND TRYING TO UNDERSTAND 1729 01:02:30,927 --> 01:02:32,795 WHAT THE EXPERTS SIDE OF THE 1730 01:02:32,795 --> 01:02:34,330 FEATURES OF DYSTONIA 1731 01:02:34,330 --> 01:02:35,632 SPECIFICALLY IN PEOPLE WITH CP 1732 01:02:35,632 --> 01:02:38,468 AND THEN TO TRY AND DEVELOP 1733 01:02:38,468 --> 01:02:39,802 QUANTITIVE METRICS OF THAT SO WE 1734 01:02:39,802 --> 01:02:43,172 LOOKED AT THE VIDEOS OF PEOPLE, 1735 01:02:43,172 --> 01:02:44,474 WE LABELED THE VIDEOS AND 1736 01:02:44,474 --> 01:02:46,776 LOOKING AT THE CERTAIN JOINTS WE 1737 01:02:46,776 --> 01:02:48,211 WERE ABLE TO LABEL AND WE USED 1738 01:02:48,211 --> 01:02:50,813 THOSE MARKERS TO DEVELOP 1739 01:02:50,813 --> 01:02:52,348 QUANTIFIABLE MEASURES OF THESE 1740 01:02:52,348 --> 01:02:53,683 QUALITATIVE EXPERTS SIDED 1741 01:02:53,683 --> 01:02:55,318 FEATURES AND ALL WITH THE 1742 01:02:55,318 --> 01:02:56,853 ULTIMATE GOAL OF TRANSLATING 1743 01:02:56,853 --> 01:02:59,555 THESE METRICS DIRECTLY TO MICE. 1744 01:02:59,555 --> 01:03:01,190 WHEN WE DID THIS IN PEOPLE, WE 1745 01:03:01,190 --> 01:03:03,693 FOUND A COUPLE OF METRICS THAT 1746 01:03:03,693 --> 01:03:07,597 TRACKED QUITE NICELY WITH 1747 01:03:07,597 --> 01:03:09,365 QUALITATIVE EXPERT RATINGS FOR 1748 01:03:09,365 --> 01:03:12,335 DYSTONIA AND ON THE X AXIS HERE, 1749 01:03:12,335 --> 01:03:14,203 SER SEW NO DYSTONIA AND EIGHT 1750 01:03:14,203 --> 01:03:15,638 MORE SEVERE AND SAME THING ON 1751 01:03:15,638 --> 01:03:17,540 THIS SIDE AND ON THE Y AXIS 1752 01:03:17,540 --> 01:03:19,876 HERE, THIS IS THE VARIABILITY OF 1753 01:03:19,876 --> 01:03:21,077 HOW CLOSE THE KNEES ARE TOGETHER 1754 01:03:21,077 --> 01:03:25,081 WHEN SOMEONE IS WALKING SO HOW 1755 01:03:25,081 --> 01:03:27,216 VARIABLE THE ABDUCTION IS OF THE 1756 01:03:27,216 --> 01:03:28,685 LEGS DURING GATE AND HERE ON THE 1757 01:03:28,685 --> 01:03:31,754 Y AXIS, IT'S FOOT ANGLE MINIMUM 1758 01:03:31,754 --> 01:03:34,524 SO THIS IS HOW CLOSE TO THE FEET 1759 01:03:34,524 --> 01:03:36,326 DO THE TOES COME TOGETHER AT ANY 1760 01:03:36,326 --> 01:03:38,661 POINT DURING GATE. 1761 01:03:38,661 --> 01:03:41,931 AND THESE METRICS WERE TIGHTLY 1762 01:03:41,931 --> 01:03:44,300 CORRELATED TO EXPERT QUALITATIVE 1763 01:03:44,300 --> 01:03:45,702 SEVERITY RANKINGS. 1764 01:03:45,702 --> 01:03:46,903 SO ABDUCTION VARIABILITY IN THE 1765 01:03:46,903 --> 01:03:52,909 LEGS AND ABDUCTION AMP ATTITUDED 1766 01:03:52,909 --> 01:03:55,011 WE SAW THIS ACROSS 1600 1767 01:03:55,011 --> 01:03:55,845 INDIVIDUALS WITH CP. 1768 01:03:55,845 --> 01:03:57,380 WE CHOSE TO APPLY THESE 1769 01:03:57,380 --> 01:03:58,715 TECHNIQUES TO LOOKING AT WHAT 1770 01:03:58,715 --> 01:04:00,650 HAPPENS IN OUR MICE AND I WILL 1771 01:04:00,650 --> 01:04:03,152 REMIND YOU THAT THIS IS WHAT A 1772 01:04:03,152 --> 01:04:05,521 MOUSE, A DY IT 1 MOUSE MOLDED 1773 01:04:05,521 --> 01:04:09,659 LOOKS LIKE A CONTROL MOUSE AND 1774 01:04:09,659 --> 01:04:12,662 HERE IS ONE OF OUR MICE THAT HAS 1775 01:04:12,662 --> 01:04:15,531 UNDERGONE THE HYPOXIC INSULT I 1776 01:04:15,531 --> 01:04:15,798 DESCRIBED. 1777 01:04:15,798 --> 01:04:17,633 A VERSION OF THAT INSULT AND 1778 01:04:17,633 --> 01:04:19,902 HERE IS A MOUSE BORN PREMATURE 1779 01:04:19,902 --> 01:04:24,040 AND THESE MICE ARE BOTH AT P35. 1780 01:04:24,040 --> 01:04:26,442 IF WE LOOKED AT VIDEOS OF HOW 1781 01:04:26,442 --> 01:04:29,645 THESE MICE MOVE, CONTROL ON THE 1782 01:04:29,645 --> 01:04:33,082 LEFT, HYPOXIA IN THE MIDDLE. 1783 01:04:33,082 --> 01:04:34,217 PREMATURE' ON THIS SIDE, THEY 1784 01:04:34,217 --> 01:04:36,219 ALL MOVE VERY DIFFERENTLY. 1785 01:04:36,219 --> 01:04:38,921 YOU SEE THAT THE CONTROL ANIMAL 1786 01:04:38,921 --> 01:04:41,657 HAS ITS LEGS AND THE HIGH POX 1787 01:04:41,657 --> 01:04:42,859 IAN MALL HAS THE LEGS MORE 1788 01:04:42,859 --> 01:04:44,360 STIFF, BROUGHT TO THE MID LINE 1789 01:04:44,360 --> 01:04:46,028 AND THIS ANIMAL THAT IS 1790 01:04:46,028 --> 01:04:49,932 EXPERIENCING PREMATURITY HAS ITS 1791 01:04:49,932 --> 01:04:51,734 LEGS STIFF AND OUT AND ABDUCTED. 1792 01:04:51,734 --> 01:04:53,569 NONE OF THESE ANIMALS LOOK 1793 01:04:53,569 --> 01:04:53,803 ALIKE. 1794 01:04:53,803 --> 01:04:55,705 NONE OF THEM ARE CLASPING BUT 1795 01:04:55,705 --> 01:04:58,307 YOU CAN SEE THAT BOTH ANIMALS 1796 01:04:58,307 --> 01:05:00,443 THAT HAS EXPERIENCED HYPOXIA AND 1797 01:05:00,443 --> 01:05:05,481 THE ANIMAL BORN PREMATURE, IT'S 1798 01:05:05,481 --> 01:05:10,186 HOLDING ITS HIND LIMBS MORE AB 1799 01:05:10,186 --> 01:05:10,453 DUCK TIVE. 1800 01:05:10,453 --> 01:05:12,355 WE CAN USE THE SAME TECHNIQUES 1801 01:05:12,355 --> 01:05:13,990 THAT WE CAN QUANTIFY LEG 1802 01:05:13,990 --> 01:05:14,957 ABDUCTION IN PEOPLE. 1803 01:05:14,957 --> 01:05:16,592 WE SEE IT ACROSS GROUPS HERE, 1804 01:05:16,592 --> 01:05:18,227 CONTROL VERSUS HYPOXIA AND 1805 01:05:18,227 --> 01:05:21,664 CONTROL VERSUS THE MICE BORN 1806 01:05:21,664 --> 01:05:23,933 PREMATURE AND THIS IS CORRECTED 1807 01:05:23,933 --> 01:05:25,568 AGE NOTING THAT THESE PREMATURE 1808 01:05:25,568 --> 01:05:26,769 MICE WERE BORN A DAY EARLY AND 1809 01:05:26,769 --> 01:05:28,404 THEY WERE ASSESSED A DAY LATER 1810 01:05:28,404 --> 01:05:30,706 THAN EVERYONE ELSE AND THESE ARE 1811 01:05:30,706 --> 01:05:33,109 THE GENETIC MODELS SO THESE ARE 1812 01:05:33,109 --> 01:05:35,945 THE MICE THAT ARE MODELS OF 1813 01:05:35,945 --> 01:05:36,379 DYT1. 1814 01:05:36,379 --> 01:05:38,748 ACROSS ALL OF THESE MICE, EVEN 1815 01:05:38,748 --> 01:05:41,451 THE MICE THAT CLASP, YOU SEE 1816 01:05:41,451 --> 01:05:44,654 THAT ABDUCTION IS THERE. 1817 01:05:44,654 --> 01:05:46,756 ANY TYPE OF INJURY ASSOCIATED 1818 01:05:46,756 --> 01:05:48,424 WITH WHAT MIGHT VISUALLY APPEAR 1819 01:05:48,424 --> 01:05:51,861 TO BE DYSTONIA IS ASSOCIATED 1820 01:05:51,861 --> 01:05:52,495 WITH THIS INCREASED ABDUCTION WE 1821 01:05:52,495 --> 01:05:53,429 FOUND TO BE A CLINICALLY 1822 01:05:53,429 --> 01:05:56,933 RELEVANT MARKER OF DYSTONIA IN 1823 01:05:56,933 --> 01:05:57,166 PEOPLE. 1824 01:05:57,166 --> 01:05:58,601 WE CAN LOOK AT THAT SAME MARKER 1825 01:05:58,601 --> 01:05:59,335 IN GATE. 1826 01:05:59,335 --> 01:06:01,337 THIS IS A CLEAR TREADMILL THAT 1827 01:06:01,337 --> 01:06:02,672 WE DEVELOPED IN THE LAB TO BE 1828 01:06:02,672 --> 01:06:05,274 ABLE TO QUANTIFY GATE METRICS 1829 01:06:05,274 --> 01:06:07,877 AND IF WE USE THIS TREADMILL 1830 01:06:07,877 --> 01:06:10,613 MARKER WE CAN LOOK AT ABDUCTION 1831 01:06:10,613 --> 01:06:12,381 OF THE LIMB TO MID LINE THROUGH 1832 01:06:12,381 --> 01:06:14,150 THE CLEAR BELT AND AGAIN USING 1833 01:06:14,150 --> 01:06:16,419 THE SAME TECHNIQUES, WE SEE THAT 1834 01:06:16,419 --> 01:06:19,021 MICE AFTER HYPOXIA AND ARE 1835 01:06:19,021 --> 01:06:19,989 PREMATURE TEE DATA FOURTH 1836 01:06:19,989 --> 01:06:24,393 COMING, WE SEE THE MICE AFTER 1837 01:06:24,393 --> 01:06:25,728 HYPOXIA DEVELOP AN ABDUCTION OF 1838 01:06:25,728 --> 01:06:27,363 THEIR LEGS FOLLOWING THE HYPOXIA 1839 01:06:27,363 --> 01:06:35,371 THAT THE CONTROLS DON'T EXIST. 1840 01:06:35,371 --> 01:06:38,074 WE BELIEVE THAT THINKING ABOUT 1841 01:06:38,074 --> 01:06:39,041 CLINICALLY RELEVANT MOTOR 1842 01:06:39,041 --> 01:06:40,576 DEVELOPMENT FEATURES IN MOUSE 1843 01:06:40,576 --> 01:06:42,111 MODELS OF BRAIN INJURY THAT ALSO 1844 01:06:42,111 --> 01:06:44,180 ARE CLINICALLY RELEVANT, AND IN 1845 01:06:44,180 --> 01:06:49,352 THAT SENSE, THEY HAVE TO BE 1846 01:06:49,352 --> 01:06:50,753 HETEROGENOUS AND CAPTURE CP 1847 01:06:50,753 --> 01:06:52,755 INSULTS THAT BOTH OF THOSE 1848 01:06:52,755 --> 01:06:53,656 TECHNIQUES TOGETHER, WE'RE 1849 01:06:53,656 --> 01:06:55,091 HOPING TO LEVERAGE THAT TO TRULY 1850 01:06:55,091 --> 01:06:58,628 GET A FULL UNDERSTANDING OF THE 1851 01:06:58,628 --> 01:07:00,263 CLINICALLY RELEVANT PATHO 1852 01:07:00,263 --> 01:07:01,130 PHYSIOLOGY THAT'S IMPORTANT FOR 1853 01:07:01,130 --> 01:07:04,066 US TO UNDERSTAND ABOUT CP. 1854 01:07:04,066 --> 01:07:06,736 SO, WE TALKED TODAY ABOUT 1855 01:07:06,736 --> 01:07:08,804 NEONATAL BRAIN INJURY, WHAT WE 1856 01:07:08,804 --> 01:07:10,673 MEAN BY MICE AND WHAT WE MEAN BY 1857 01:07:10,673 --> 01:07:11,507 BRAIN INJURY. 1858 01:07:11,507 --> 01:07:14,777 AND I MADE AN ARGUMENT FOR THE 1859 01:07:14,777 --> 01:07:17,146 VALUE IN BEHAVIORALIST AND AS A 1860 01:07:17,146 --> 01:07:18,948 MOVEMENT DISORDER PHYSICIAN 1861 01:07:18,948 --> 01:07:20,483 SCIENTIST, THINKING ABOUT MOTOR 1862 01:07:20,483 --> 01:07:21,017 DEVELOPMENT. 1863 01:07:21,017 --> 01:07:23,352 AND THINKING ABOUT HOW OUR 1864 01:07:23,352 --> 01:07:27,657 MODELS OF NEONATAL BRAIN INJURY 1865 01:07:27,657 --> 01:07:29,992 DON'T JUST RECAPITULATE SOME 1866 01:07:29,992 --> 01:07:34,397 FUNCTIONAL IMPAIRMENT BUT HOW 1867 01:07:34,397 --> 01:07:36,165 THEY REKA PIT TAUGHT LATE THE 1868 01:07:36,165 --> 01:07:38,100 MOTOR IN CLINIC AND IN OUR 1869 01:07:38,100 --> 01:07:38,467 FAMILIES. 1870 01:07:38,467 --> 01:07:39,869 I'D LIKE TO THANK EVERYBODY 1871 01:07:39,869 --> 01:07:40,937 INVOLVED IN THIS WORK 1872 01:07:40,937 --> 01:07:43,439 PARTICULARLY THIS GROUP OF 1873 01:07:43,439 --> 01:07:46,042 TRAINEES, ESTHER AND CAT. 1874 01:07:46,042 --> 01:07:47,677 WHO HAVE DONE THE PAINSTAKING 1875 01:07:47,677 --> 01:07:50,079 WORK OF COLLECTING A LOT OF THIS 1876 01:07:50,079 --> 01:07:50,279 DATA. 1877 01:07:50,279 --> 01:07:54,450 AND MY FUNDING SOURCES. 1878 01:07:54,450 --> 01:07:55,518 THANK YOU. 1879 01:07:55,518 --> 01:07:58,254 >> HELLO, MIME MICHAEL KRUER 1880 01:07:58,254 --> 01:07:59,889 JOINING YOU FROM PHOENIX, 1881 01:07:59,889 --> 01:08:02,792 ARIZONA TO TALK ABOUT GENOMIC 1882 01:08:02,792 --> 01:08:03,693 INSIGHTS INTO CEREBRAL PALSY. 1883 01:08:03,693 --> 01:08:05,161 MY THANKS TO THE ORGANIZERS FOR 1884 01:08:05,161 --> 01:08:06,195 THE OPPORTUNITY TO SHARE THIS 1885 01:08:06,195 --> 01:08:09,332 WORK WITH ALL OF US. 1886 01:08:09,332 --> 01:08:10,633 IT'S HARD TO BELIEVE BUT IT'S 1887 01:08:10,633 --> 01:08:12,034 BEEN OVER A YEAR AND A HALF 1888 01:08:12,034 --> 01:08:15,738 SINCE THE PUBLICATION OF OUR 1889 01:08:15,738 --> 01:08:16,939 WORLDWIDE EFFORT THAT LED TO 1890 01:08:16,939 --> 01:08:18,608 THIS PAPER BEING PUBLISHED IN 1891 01:08:18,608 --> 01:08:21,043 NATURE GENETICS. 1892 01:08:21,043 --> 01:08:24,013 THIS PROJECT WAS LED BY THREE 1893 01:08:24,013 --> 01:08:28,284 POSTDOCS, SARAH LEWIS, SOMAYEH 1894 01:08:28,284 --> 01:08:31,087 AND PETER JIN. 1895 01:08:31,087 --> 01:08:33,990 AND ASSISTANT PROFESSOR AT 1896 01:08:33,990 --> 01:08:34,857 WASHINGTON UNIVERSITY. 1897 01:08:34,857 --> 01:08:36,525 THIS PAPER SHOWED FOR THE FIRST 1898 01:08:36,525 --> 01:08:38,194 TIME STATISTICAL AND FUNCTIONAL 1899 01:08:38,194 --> 01:08:40,029 EVIDENCE THAT GENETIC MUTATIONS 1900 01:08:40,029 --> 01:08:42,498 CAN RESULT IN CP. 1901 01:08:42,498 --> 01:08:43,666 FURTHERMORE, SINCE THAT TIME, 1902 01:08:43,666 --> 01:08:45,434 THERE HAVE BEEN A NUMBER OF 1903 01:08:45,434 --> 01:08:46,636 IMPORTANT FOLLOW UPS STUDIES 1904 01:08:46,636 --> 01:08:48,270 THAT HAVE BEEN PUBLISHED. 1905 01:08:48,270 --> 01:08:49,672 COP OBJECT RATING AND EXTENDING 1906 01:08:49,672 --> 01:08:52,608 THE FINDINGS OF THE GENETICS 1907 01:08:52,608 --> 01:08:52,942 PAPER. 1908 01:08:52,942 --> 01:08:54,543 THIS POINT IN TIME I THINK IT'S 1909 01:08:54,543 --> 01:08:56,846 CLEAR THAT FOR SOME INDIVIDUALS 1910 01:08:56,846 --> 01:08:58,047 WITH CEREBRAL PALSY, THE CAUSE 1911 01:08:58,047 --> 01:09:02,985 OF THE SYMPTOMS IS GENETIC. 1912 01:09:02,985 --> 01:09:04,920 ONE POTENTIAL CRITICISM OF THIS 1913 01:09:04,920 --> 01:09:07,256 WORK THOUGH IS THIS REALLY 1914 01:09:07,256 --> 01:09:07,857 CEREBRAL PALSY? 1915 01:09:07,857 --> 01:09:09,258 AND IN RESPONSE, I WOULD SAY 1916 01:09:09,258 --> 01:09:10,826 THAT FUNDAMENTALLY CEREBRAL 1917 01:09:10,826 --> 01:09:13,562 PALSY IS A CLINICAL DIAGNOSIS. 1918 01:09:13,562 --> 01:09:15,765 ITS DEFINITION IS REALLY 1919 01:09:15,765 --> 01:09:19,368 INDEPENDENT OF IDEOLOGY. 1920 01:09:19,368 --> 01:09:22,304 OTHER MAJOR DISABILITIES, AUTISM 1921 01:09:22,304 --> 01:09:27,443 AND EPILEPSIES ARE AGNOSTIC TO 1922 01:09:27,443 --> 01:09:28,177 ETIOLOGY AS WELL. 1923 01:09:28,177 --> 01:09:29,445 IT'S DIFFICULT TO DISTINGUISH 1924 01:09:29,445 --> 01:09:32,314 CASES OF GENETIC CP FROM CASES 1925 01:09:32,314 --> 01:09:34,517 OF CP THAT MIGHT BE DUE TO MORE 1926 01:09:34,517 --> 01:09:37,119 CONVENTIONAL RISK FACTORS LIKE 1927 01:09:37,119 --> 01:09:46,462 PREMATURITY OR HIGHIA ESCHEMIC. 1928 01:09:46,462 --> 01:09:48,230 AND IF YOU LOOK AT THE PANEL ON 1929 01:09:48,230 --> 01:09:50,966 THE RIGHT YOU WILL SEE AN MRI 1930 01:09:50,966 --> 01:09:53,369 MONTAGE HIGHLIGHTING INJURY 1931 01:09:53,369 --> 01:10:00,609 PATTERNS AND INCLUDING POTENTIAL 1932 01:10:00,609 --> 01:10:01,677 ISCHEMIC INJURY AND ALL OF WHICH 1933 01:10:01,677 --> 01:10:03,979 COULD BE COMPATIBLE WITH THE CP 1934 01:10:03,979 --> 01:10:05,281 DIAGNOSIS AND SEEING IN 1935 01:10:05,281 --> 01:10:07,450 INDIVIDUALS WITH CP AND QUITE 1936 01:10:07,450 --> 01:10:09,518 INTERESTINGLY, ALL OF THESE 1937 01:10:09,518 --> 01:10:11,053 INDIVIDUALS AS IT TURNS OUT HAVE 1938 01:10:11,053 --> 01:10:12,988 MUTATIONS IN A SINGLE GENE 1939 01:10:12,988 --> 01:10:15,091 CALLED 4A1. 1940 01:10:15,091 --> 01:10:16,158 POTENTIALLY CHALLENGING SOME OF 1941 01:10:16,158 --> 01:10:17,793 OUR CLINICALLY HELD NOTIONS 1942 01:10:17,793 --> 01:10:20,162 ABOUT CP CAUSALITY. 1943 01:10:20,162 --> 01:10:22,998 IT MAY BE TIME FOR A DATA 1944 01:10:22,998 --> 01:10:31,307 APPROACH WHEN IT COMES TO CP. 1945 01:10:31,307 --> 01:10:32,842 MOST OF THE FORMS OF CP WE'VE 1946 01:10:32,842 --> 01:10:34,477 IDENTIFIED TO DATE HAVE 1947 01:10:34,477 --> 01:10:35,845 REPRESENTED LOW-HANGING FRUIT 1948 01:10:35,845 --> 01:10:39,014 AND THESE ARE SINGLE GENE 1949 01:10:39,014 --> 01:10:39,348 DISORDERS. 1950 01:10:39,348 --> 01:10:41,117 CONDITIONS WHERE A MUTATION IN A 1951 01:10:41,117 --> 01:10:43,786 SINGLE GENE IS ENOUGH TO TIP THE 1952 01:10:43,786 --> 01:10:45,387 SCALES FROM HEALTH TO DISEASE 1953 01:10:45,387 --> 01:10:48,791 AND SUCH MUTATIONS ARE OF 1954 01:10:48,791 --> 01:10:51,894 RELATIVELY LARGE EFFECT SIZE. 1955 01:10:51,894 --> 01:10:54,730 HOWEVER, MORE COMPLEX GENETIC 1956 01:10:54,730 --> 01:10:56,599 MECHANISMS CONTRIBUTE TO CP AS 1957 01:10:56,599 --> 01:10:58,501 WELL ALTHOUGH AT THIS POINT IN 1958 01:10:58,501 --> 01:11:00,002 TIME, THEY'VE REMAINED A BLACK 1959 01:11:00,002 --> 01:11:00,169 BOX. 1960 01:11:00,169 --> 01:11:01,537 THERE MIGHT BE SOME EXCITING 1961 01:11:01,537 --> 01:11:04,073 OPPORTUNITIES TO LOOK AT COMPLEX 1962 01:11:04,073 --> 01:11:07,243 FEATURES SUCH AS GENE-BY-GENE 1963 01:11:07,243 --> 01:11:08,544 AND GENE BY ENVIRONMENTAL 1964 01:11:08,544 --> 01:11:12,348 INTERACTIONS IN THE FUTURE. 1965 01:11:12,348 --> 01:11:14,450 LATER IN THE WORKSHOP WE'LL HEAR 1966 01:11:14,450 --> 01:11:16,452 ABOUT STAKEHOLDER ENGAGEMENT AND 1967 01:11:16,452 --> 01:11:17,987 TIN INCLUDES FAMILIAR LOWS AND 1968 01:11:17,987 --> 01:11:18,287 CLINICIANS. 1969 01:11:18,287 --> 01:11:21,423 FOR EXAMPLE, OUR WORK CONDUCTED 1970 01:11:21,423 --> 01:11:23,259 BY MY CLINICAL RESEARCH TEAM 1971 01:11:23,259 --> 01:11:25,194 WOULD NOT BE POSSIBLE WITHOUT 1972 01:11:25,194 --> 01:11:27,897 THE COLLABORATION AND SUPPORT OF 1973 01:11:27,897 --> 01:11:29,565 THIS CEREBRAL PALSY RESEARCH 1974 01:11:29,565 --> 01:11:29,865 NETWORK. 1975 01:11:29,865 --> 01:11:32,334 WE'LL HEAR ABOUT THE CPRN LATER 1976 01:11:32,334 --> 01:11:34,303 BUT THIS IS A NATIONWIDE 1977 01:11:34,303 --> 01:11:35,504 COLLABORATIVE COMPRISED OF 1978 01:11:35,504 --> 01:11:37,373 CENTERS OF EXCELLENCE AND CP 1979 01:11:37,373 --> 01:11:38,908 CARE, TRYING TO ESTABLISH BOTH 1980 01:11:38,908 --> 01:11:43,512 STANDARDS FOR CP. 1981 01:11:43,512 --> 01:11:45,080 IN ADDITION, IT'S ALSO BEEN SAID 1982 01:11:45,080 --> 01:11:47,349 IT CAN TAKE UP TO 10 YEARS FOR 1983 01:11:47,349 --> 01:11:49,718 NEW KNOWLEDGE TO BE IMPLEMENTED 1984 01:11:49,718 --> 01:11:51,854 INTO PRACTICE AND PERHAPS MORE. 1985 01:11:51,854 --> 01:11:55,057 AND ON THIS NOTE, THIS PAPER, 1986 01:11:55,057 --> 01:11:57,193 LED BY BHOOMA, DEMONSTRATED THAT 1987 01:11:57,193 --> 01:12:02,264 A SERIES OF VINIERS NEVERTHELESS 1988 01:12:02,264 --> 01:12:04,834 LED TO CONSIDERABLE VARIABILITY 1989 01:12:04,834 --> 01:12:07,469 IN HOW THEY WOULD DIAGNOSE 1990 01:12:07,469 --> 01:12:07,837 CEREBRAL PALSY. 1991 01:12:07,837 --> 01:12:10,339 EVEN WHEN PRESENTED WITH THE 1992 01:12:10,339 --> 01:12:11,273 CONSENSUS DEFINITION. 1993 01:12:11,273 --> 01:12:13,776 MAJOR POINTS OF THIS AGREEMENT 1994 01:12:13,776 --> 01:12:14,977 INCLUDED HYPO TONIC PC AS WELL 1995 01:12:14,977 --> 01:12:17,246 AS GENETIC IDEOLOGY BUT THIS 1996 01:12:17,246 --> 01:12:18,747 ARGUES FOR THE IMPORTANCE OF ON 1997 01:12:18,747 --> 01:12:20,282 GOING DYING A LOG WITH 1998 01:12:20,282 --> 01:12:21,684 CLINICIANS IN THE FACE OF NEW 1999 01:12:21,684 --> 01:12:25,020 RESEARCH FINDINGS. 2000 01:12:25,020 --> 01:12:26,388 BEFORE WE GO TOO MUCH FURTHER, 2001 01:12:26,388 --> 01:12:28,591 IT'S IMPORTANT TO RECOGNIZE THAT 2002 01:12:28,591 --> 01:12:30,492 CEREBRAL PALSY GENE DISCOVERY 2003 01:12:30,492 --> 01:12:32,728 FUNDAMENTALLY REQUIRES A 2004 01:12:32,728 --> 01:12:34,163 TRANSLATIONAL APPROACH AND SO 2005 01:12:34,163 --> 01:12:37,333 EXCELLENCE IN BIO INFORMATICS 2006 01:12:37,333 --> 01:12:39,401 AND WE'RE FORTUNATE TO HAVE AN 2007 01:12:39,401 --> 01:12:41,770 EXCELLENT TEAM IN PHOENIX AND A 2008 01:12:41,770 --> 01:12:43,172 WONDERFUL COLLABORATION WITH OUR 2009 01:12:43,172 --> 01:12:44,607 COLLEAGUES AT WASHU. 2010 01:12:44,607 --> 01:12:48,177 BUT THIS REPRESENTS ONE SIDE OF 2011 01:12:48,177 --> 01:12:48,878 THE COIN AND IDENTIFYING 2012 01:12:48,878 --> 01:12:52,882 PRIORITY GENOMIC VARIANTS IS IT 2013 01:12:52,882 --> 01:12:54,783 SOMETIMES THE ONLY THE BEGINNING 2014 01:12:54,783 --> 01:12:56,785 AS POTENTIAL MUTATIONS NEED TO 2015 01:12:56,785 --> 01:12:59,221 BE CONFIRMED AND VALIDATED. 2016 01:12:59,221 --> 01:13:01,156 THIS VALIDATION CAN TAKE A 2017 01:13:01,156 --> 01:13:03,158 VARIETY OF FORMS INCLUDING 2018 01:13:03,158 --> 01:13:04,693 EXPERIMENTS IN CELL LINES WHERE 2019 01:13:04,693 --> 01:13:07,663 USING OMICS TECHNOLOGIES AND 2020 01:13:07,663 --> 01:13:11,300 POTENTIALLY RETURNING TO ASSESS 2021 01:13:11,300 --> 01:13:14,136 PROTEIN MODEL. 2022 01:13:14,136 --> 01:13:16,105 INCREASINGLY, ANIMAL MODEL MUCH 2023 01:13:16,105 --> 01:13:17,306 CP WHETHER THEY'RE FLY MODEL 2024 01:13:17,306 --> 01:13:18,374 WHICH YOU WILL HEAR MORE ABOUT 2025 01:13:18,374 --> 01:13:21,677 IN A FEW SLIDES, OR ZEBRAFISH 2026 01:13:21,677 --> 01:13:24,480 MODELS, SUCH AS THIS ONE THAT 2027 01:13:24,480 --> 01:13:26,148 WAS UNDERTAKEN IN COLLABORATION 2028 01:13:26,148 --> 01:13:33,822 WITH MICHAEL FAYHE AND JAN 2029 01:13:33,822 --> 01:13:35,491 KASLIN ARE TAKING LIGHT IN 2030 01:13:35,491 --> 01:13:36,258 MECHANISM DISEASE. 2031 01:13:36,258 --> 01:13:41,497 WHAT DID WE LEARN SO FAR? 2032 01:13:41,497 --> 01:13:42,398 MUTATIONS ARE ENRICHED IN CP AND 2033 01:13:42,398 --> 01:13:44,867 THIS IS IMPORTANT BECAUSE FOR 2034 01:13:44,867 --> 01:13:46,769 SOME TIME, WE'VE KNOWN THAT 2035 01:13:46,769 --> 01:13:48,804 PARTICULARLY IN THE UNITED 2036 01:13:48,804 --> 01:13:53,475 STATES, CP TENDS TO BE SPORADIC 2037 01:13:53,475 --> 01:13:54,543 OCCURRENCE. 2038 01:13:54,543 --> 01:13:57,713 DE NOVO MUTATIONS ARE COMMON IN 2039 01:13:57,713 --> 01:13:59,949 NEURO DISORDERS AND OCCUR WHEN A 2040 01:13:59,949 --> 01:14:01,750 GENETICALLY HEALTHY FATHER AND 2041 01:14:01,750 --> 01:14:02,418 HEALTHY MOTHER NEVERTHELESS, 2042 01:14:02,418 --> 01:14:07,923 HAVE AN EFFECTED CHILD. 2043 01:14:07,923 --> 01:14:11,760 WHO DE NOVO DEVELOPS. 2044 01:14:11,760 --> 01:14:14,830 WE HAVE IDENTIFIED KEY PATHWAYS 2045 01:14:14,830 --> 01:14:19,101 MANY CONTROL DEVELOPMENTAL KEN P 2046 01:14:19,101 --> 01:14:20,035 CONNECTIVITY AND THE 2047 01:14:20,035 --> 01:14:21,837 REPRESENTATION OF THE CYTO 2048 01:14:21,837 --> 01:14:22,972 SKELETON HAS BEEN IMPORTANT. 2049 01:14:22,972 --> 01:14:25,140 THIS IS A TIME LAPSED VIDEO OF A 2050 01:14:25,140 --> 01:14:27,943 NEURON IN CULTURE FROM TOBIAS 2051 01:14:27,943 --> 01:14:28,277 MYERS LAB. 2052 01:14:28,277 --> 01:14:31,480 YOU CAN SEE THAT AK TIN HAS BEEN 2053 01:14:31,480 --> 01:14:35,384 LABELED SO WAVES OF ACTIN COME 2054 01:14:35,384 --> 01:14:38,220 OUT FROM THE SOMA AND SOME OF 2055 01:14:38,220 --> 01:14:40,022 THESE WAVES OF FIZZLE OUT WHILE 2056 01:14:40,022 --> 01:14:42,124 OTHERS ACTUALLY DRIVE EXTENSION 2057 01:14:42,124 --> 01:14:44,793 IN ACTIVE FASHION. 2058 01:14:44,793 --> 01:14:46,095 ALTHOUGH FURTHER STUDIES WILL BE 2059 01:14:46,095 --> 01:14:49,164 NEEDED TO UNDER THE MECHANISMS 2060 01:14:49,164 --> 01:14:57,172 BETTER, NEVERTHELESS, IT'S 2061 01:14:57,172 --> 01:14:58,140 FASCINATING SOME OF THE 2062 01:14:58,140 --> 01:15:00,275 MUTATIONS THAT IN THE COHORTS 2063 01:15:00,275 --> 01:15:01,677 SEQUENCES THUS FAR ARE PREDICTED 2064 01:15:01,677 --> 01:15:03,412 TO EFFECT THESE FUNDAMENTAL 2065 01:15:03,412 --> 01:15:05,047 MECHANISMS ARE NEURON 2066 01:15:05,047 --> 01:15:07,783 DEVELOPMENT AND CONNECTIVITY. 2067 01:15:07,783 --> 01:15:08,584 FURTHERMORE, WE'VE RECOGNIZED 2068 01:15:08,584 --> 01:15:10,886 THAT THERE IS A SUBSTANTIAL 2069 01:15:10,886 --> 01:15:13,589 CLINICAL AND GENETIC OVERLAP 2070 01:15:13,589 --> 01:15:14,957 WITH OTHER NEURAL DEVELOPMENT 2071 01:15:14,957 --> 01:15:16,392 DISORDERS AND MANY OF THE SAME 2072 01:15:16,392 --> 01:15:17,826 GENES, ALTHOUGH NOT ALL, THAT 2073 01:15:17,826 --> 01:15:23,732 HAVE BEEN IMPLICATED HAVE BEEN 2074 01:15:23,732 --> 01:15:26,168 IN OTHER NEURAL DISORDERS. 2075 01:15:26,168 --> 01:15:27,403 IN ADDITION, WE'VE LEARNED WE 2076 01:15:27,403 --> 01:15:28,904 HAVE A LOT TO LEARN. 2077 01:15:28,904 --> 01:15:30,039 THERE ARE CURRENTLY THOUGHT TO 2078 01:15:30,039 --> 01:15:32,441 BE HUNDREDS OF CP GENES THAT 2079 01:15:32,441 --> 01:15:34,309 EXIST BUT MANY OF THESE STILL 2080 01:15:34,309 --> 01:15:35,511 AWAIT DISCOVERY. 2081 01:15:35,511 --> 01:15:38,013 AND THIS IS JUST THE 2082 01:15:38,013 --> 01:15:40,382 REPRESENTATIVE EXAMPLE OF SOME 2083 01:15:40,382 --> 01:15:42,284 OF THE GENE DISCOVERIES THAT OUR 2084 01:15:42,284 --> 01:15:44,887 GROUP HAS BEEN INVOLVED IN. 2085 01:15:44,887 --> 01:15:46,789 SOME STUDIES WE'VE LED AND SOME 2086 01:15:46,789 --> 01:15:48,223 WE'VE COLLABORATED ON BUT EACH 2087 01:15:48,223 --> 01:15:49,992 OF THESE REPRESENTED IN AN 2088 01:15:49,992 --> 01:15:55,264 IMPORTANT DISCOVERY IN IT'S OWN 2089 01:15:55,264 --> 01:15:55,464 RIGHT. 2090 01:15:55,464 --> 01:15:56,665 A NUMBER OF THINGS HAVE 2091 01:15:56,665 --> 01:15:57,299 SURPRISED US. 2092 01:15:57,299 --> 01:15:58,600 ONE OF THE THINGS THAT'S BEEN 2093 01:15:58,600 --> 01:16:01,070 FASCINATING TO LEARN IS HOW 2094 01:16:01,070 --> 01:16:02,838 VARIABLE NDD PRESENTATIONS CAN 2095 01:16:02,838 --> 01:16:03,172 BE. 2096 01:16:03,172 --> 01:16:05,441 SO FOR EXAMPLE, WE NOW HAVE 2097 01:16:05,441 --> 01:16:06,975 EVIDENCE THAT MUTATIONS IN THE 2098 01:16:06,975 --> 01:16:08,977 SAME GENE CAN SOMETIMES LEAD TO 2099 01:16:08,977 --> 01:16:11,213 CP AND SOMETIMES LEAD TO OTHER 2100 01:16:11,213 --> 01:16:12,815 NEURO DEVELOPMENTAL DISORDERS. 2101 01:16:12,815 --> 01:16:13,816 SOMETIMES CO OCCURRING AND 2102 01:16:13,816 --> 01:16:15,717 SOMETIMES IN ISOLATION. 2103 01:16:15,717 --> 01:16:18,220 WE ALSO HAVE NEW EVIDENCE THAT 2104 01:16:18,220 --> 01:16:19,721 MUTATIONS AND SOME OF THE SAME 2105 01:16:19,721 --> 01:16:22,624 GENES THAT CAN LEAD TO CP, CAN 2106 01:16:22,624 --> 01:16:25,227 ALSO LEAD TO ADULT ONSET OR 2107 01:16:25,227 --> 01:16:28,030 PROGRESSIVE PHENOTYPES AND A AN 2108 01:16:28,030 --> 01:16:30,365 EXCELLENT EXAMPLE IS FROM 2109 01:16:30,365 --> 01:16:31,633 MICHAEL'S GROUP WHICH THEY 2110 01:16:31,633 --> 01:16:34,369 SHOWED VARIANTS IN CHDA MOST 2111 01:16:34,369 --> 01:16:36,405 OFTEN ASSOCIATED WITH AUTISM CAN 2112 01:16:36,405 --> 01:16:37,973 ALSO BE ASSOCIATED WITH 2113 01:16:37,973 --> 01:16:40,843 PROGRESSIVE DYSTONIA IN CERTAIN 2114 01:16:40,843 --> 01:16:41,510 PATIENTS. 2115 01:16:41,510 --> 01:16:43,545 REALLY HIGHLIGHTING SOME OF THE 2116 01:16:43,545 --> 01:16:44,746 VARIABILITY THAT WE SEE IN 2117 01:16:44,746 --> 01:16:48,317 CLINICAL PRESENTATION. 2118 01:16:48,317 --> 01:16:49,485 FURTHERMORE, THIS IS ALSO 2119 01:16:49,485 --> 01:16:53,388 ILLUSTRATED IN THE EXAMPLE THAT 2120 01:16:53,388 --> 01:16:55,190 HEREDITARY SPASTIC PARAPLEGIC 2121 01:16:55,190 --> 01:16:56,725 WHERE WE'VE KNOWN MUTATIONS IN 2122 01:16:56,725 --> 01:16:58,627 THESE GENES CAN LEAD TO DOUGH 2123 01:16:58,627 --> 01:17:00,863 GENERATIVE AND PROGRESSIVE 2124 01:17:00,863 --> 01:17:01,363 PHENOTYPES. 2125 01:17:01,363 --> 01:17:02,898 THEY SUGGEST THAT MUTATION IN 2126 01:17:02,898 --> 01:17:04,299 SOME GENES CLASSICALLY 2127 01:17:04,299 --> 01:17:08,570 ASSOCIATED WITH HSP SUCH AS ATL1 2128 01:17:08,570 --> 01:17:12,341 WITH LEAD TO CEREBRAL PALSY 2129 01:17:12,341 --> 01:17:13,308 PHENOTYPES. 2130 01:17:13,308 --> 01:17:15,077 ANOTHER SURPRISE THAT'S BEEN 2131 01:17:15,077 --> 01:17:17,212 DESPITE THE BREADTH OF GENETIC 2132 01:17:17,212 --> 01:17:18,380 FINDINGS IN CEREBRAL PALSY, THEY 2133 01:17:18,380 --> 01:17:20,048 CAN PROMPT CHANGES IN 2134 01:17:20,048 --> 01:17:20,349 MANAGEMENT. 2135 01:17:20,349 --> 01:17:22,050 AND THIS IS AN ACTIVE PROJECT 2136 01:17:22,050 --> 01:17:25,220 THAT IS STILL UNDERWAY. 2137 01:17:25,220 --> 01:17:26,955 THERE'S AN INTERNATIONAL WORKING 2138 01:17:26,955 --> 01:17:29,224 GROUP OF CONTENT EXPERTS AND 2139 01:17:29,224 --> 01:17:32,161 CEREBRAL PALSY GENETICS THAT'S 2140 01:17:32,161 --> 01:17:32,427 INVOLVED. 2141 01:17:32,427 --> 01:17:35,264 WHAT THIS WORKING GROUP HAS 2142 01:17:35,264 --> 01:17:37,199 DONE, TO REVIEW PUBLISHED DATA 2143 01:17:37,199 --> 01:17:39,134 FROM CP GENETIC STUDIES CLINICAL 2144 01:17:39,134 --> 01:17:41,737 AND RESEARCH STUDIES. 2145 01:17:41,737 --> 01:17:44,173 IT HAS REVEALED SEVERAL HUNDRED 2146 01:17:44,173 --> 01:17:46,241 GENES POTENTIALLY INVOLVED IN 2147 01:17:46,241 --> 01:17:46,975 CEREBRAL PALSY. 2148 01:17:46,975 --> 01:17:49,011 IN FOLLOW-UP REVIEW, HAS SHOWN 2149 01:17:49,011 --> 01:17:50,512 THAT IN A SURPRISING PREPORTION 2150 01:17:50,512 --> 01:17:53,081 OF CASES, THE IDENTIFICATION OF 2151 01:17:53,081 --> 01:17:56,051 THE GENETIC MUTATION IN ITS 2152 01:17:56,051 --> 01:17:57,219 SPECIFIC GENE MAY ACTUALLY 2153 01:17:57,219 --> 01:17:58,520 PROMPT A CHANGE IN MANAGEMENT 2154 01:17:58,520 --> 01:18:02,724 AND AN OPPORTUNITY FOR PRECISION 2155 01:18:02,724 --> 01:18:03,125 MEDICINE. 2156 01:18:03,125 --> 01:18:06,028 THIS IS UNPUBLISHED DATA THAT 2157 01:18:06,028 --> 01:18:08,964 SHOWS THAT FOR 25% OF THE GENES 2158 01:18:08,964 --> 01:18:12,701 THAT ARE IDENTIFIED BY CEREBRAL 2159 01:18:12,701 --> 01:18:13,835 PALSY GENE SEC WEDNESDAYING THIS 2160 01:18:13,835 --> 01:18:15,237 EXPECTED TO PROMPT A CHANGE IN 2161 01:18:15,237 --> 01:18:15,604 CARE. 2162 01:18:15,604 --> 01:18:17,839 IN SOME CASES ALLOWING PATIENTS 2163 01:18:17,839 --> 01:18:18,907 TO AVOID COMPLICATION AND IN 2164 01:18:18,907 --> 01:18:24,513 OTHER CASES, PROMPTING ACTUAL 2165 01:18:24,513 --> 01:18:27,316 CHANGE THIS TREATMENT OR THE 2166 01:18:27,316 --> 01:18:28,517 APPLICATION OF A NEW TREATMENT. 2167 01:18:28,517 --> 01:18:31,453 THESE ARE EXCITING HOWEVER IT'S 2168 01:18:31,453 --> 01:18:32,654 IMPORTANT TO POINT OUT THE 2169 01:18:32,654 --> 01:18:33,222 CAVEATS AS WELL. 2170 01:18:33,222 --> 01:18:35,958 WE KNOW THAT 62% OF THESE 2171 01:18:35,958 --> 01:18:38,060 ACTIONABLE GENES ACTUALLY HAVE 2172 01:18:38,060 --> 01:18:39,962 WEAK EVIDENCE SUPPORTING THEM. 2173 01:18:39,962 --> 01:18:42,331 EVIDENCE CLASS D OR LOWER. 2174 01:18:42,331 --> 01:18:45,267 BEGGING TO QUESTION WHAT DO WE 2175 01:18:45,267 --> 01:18:46,001 DO? 2176 01:18:46,001 --> 01:18:48,003 WELL THERE'S BEEN AN INCREASED 2177 01:18:48,003 --> 01:18:51,106 EMPHASIS ON THE POSSIBLE UTILITY 2178 01:18:51,106 --> 01:18:54,743 OF STUDIES FOR NEURO 2179 01:18:54,743 --> 01:18:55,344 DEVELOPMENTAL DISORDERS, 2180 01:18:55,344 --> 01:18:57,546 PARTICULARLY GENETIC ONES. 2181 01:18:57,546 --> 01:19:00,849 AND IF CAREFULLY CONDUCTED, CAN 2182 01:19:00,849 --> 01:19:02,484 ACTUALLY OFFER THE OPPORTUNITY 2183 01:19:02,484 --> 01:19:04,653 FOR HIGH-LEVEL EVIDENCE AND 2184 01:19:04,653 --> 01:19:06,622 ESSENTIALLY THESE STUDIES USE 2185 01:19:06,622 --> 01:19:10,125 EACH PATIENT AS HIS OR HER OWN 2186 01:19:10,125 --> 01:19:11,093 CONTROL GOING THROUGH A SERIES 2187 01:19:11,093 --> 01:19:14,997 OF REPEATED MEASURES IN WHICH 2188 01:19:14,997 --> 01:19:17,099 QUANTITIVE DATA IS TAKEN AT FACE 2189 01:19:17,099 --> 01:19:18,867 LINE FOLLOWED BY A INTERVENTION 2190 01:19:18,867 --> 01:19:21,136 OR PLACEBO AND WITH AN 2191 01:19:21,136 --> 01:19:23,038 INTERVENTION AND SO ESSENTIALLY, 2192 01:19:23,038 --> 01:19:24,806 THE PATIENT'S RESPONSE TO THE 2193 01:19:24,806 --> 01:19:30,579 INTERCEPTIONS CAN BE ASSESSED. 2194 01:19:30,579 --> 01:19:33,048 ALTHOUGH WE'LL HAVE TO SEE WHERE 2195 01:19:33,048 --> 01:19:34,149 THE TRIALS WILL TAKE US, THIS 2196 01:19:34,149 --> 01:19:35,684 OFFERS EXCITING OPPORTUNITIES AS 2197 01:19:35,684 --> 01:19:37,686 EARLY INTERVENTION OVER TIME, 2198 01:19:37,686 --> 01:19:39,688 MAY BE BECOMING INCREASINGLY 2199 01:19:39,688 --> 01:19:42,858 MEDICAL AS WELL AS THERAPY 2200 01:19:42,858 --> 01:19:43,125 BASED. 2201 01:19:43,125 --> 01:19:45,093 IN ADDITION, SOME STUDIES OF 2202 01:19:45,093 --> 01:19:46,662 GENETIC FORMS OF CP ARE STARTING 2203 01:19:46,662 --> 01:19:48,397 TO TEACH US NEW THINGS ABOUT 2204 01:19:48,397 --> 01:19:51,099 NORMAL HUMAN BRAIN DEVELOPMENT. 2205 01:19:51,099 --> 01:19:52,267 AS AN EXAMPLE I'M GOING TO TELL 2206 01:19:52,267 --> 01:19:54,169 YOU ABOUT A COLLABORATIVE STUDY 2207 01:19:54,169 --> 01:19:59,308 WE'RE WORKING ON WITH ALEX 2208 01:19:59,308 --> 01:19:59,541 KENTSIS. 2209 01:19:59,541 --> 01:20:02,511 THE BRAIN IS A MOSAIC IS EACH 2210 01:20:02,511 --> 01:20:04,279 NEURON MAY HAVE A DIFFERENT 2211 01:20:04,279 --> 01:20:06,615 GENETIC MAKE UP THAN ITS 2212 01:20:06,615 --> 01:20:07,082 NEIGHBOR. 2213 01:20:07,082 --> 01:20:08,850 THIS IS INVOKED TO EXPLAIN SOME 2214 01:20:08,850 --> 01:20:10,852 CAUSES OF DISEASE, PARTICULARLY 2215 01:20:10,852 --> 01:20:11,720 NEUROLOGICAL DISORDERS THAT 2216 01:20:11,720 --> 01:20:15,557 EFFECT THE DEVELOPMENT SUCH AS 2217 01:20:15,557 --> 01:20:17,392 EPILEPSIES. 2218 01:20:17,392 --> 01:20:18,894 HOWEVER, THROUGH UNBIASED 2219 01:20:18,894 --> 01:20:22,531 SEQUENCING STUDIES, IN THIS 2220 01:20:22,531 --> 01:20:24,199 CASE, IN POPULATIONS WE 2221 01:20:24,199 --> 01:20:26,201 IDENTIFIED TWO FAMILIES EACH 2222 01:20:26,201 --> 01:20:29,271 AFFECTED BY CP AS WELL AS 2223 01:20:29,271 --> 01:20:30,539 INTELLECTUAL DISABILITY, AUTISM 2224 01:20:30,539 --> 01:20:32,174 AND EPILEPSIES AND EACH FAMILY 2225 01:20:32,174 --> 01:20:35,811 HAD TWO EFFECTED CHILDREN AND 2226 01:20:35,811 --> 01:20:38,213 EACH OF THE CHILDREN HARBORED A 2227 01:20:38,213 --> 01:20:42,417 LOSS OF FUNCTION IN MUTATION IN 2228 01:20:42,417 --> 01:20:42,617 PGBD5. 2229 01:20:42,617 --> 01:20:44,553 THESE WERE PREDICTED TO LEAD TO 2230 01:20:44,553 --> 01:20:46,488 COMPLETE GENOMIC KNOCK OUT OF 2231 01:20:46,488 --> 01:20:47,255 THE GENE. 2232 01:20:47,255 --> 01:20:50,092 ESSENTIALLY NO FUNCTIONING GENE 2233 01:20:50,092 --> 01:20:50,325 PRODUCT. 2234 01:20:50,325 --> 01:20:54,863 WHEN INTERESTINGLY, PGB5 IS A 2235 01:20:54,863 --> 01:20:55,897 TRANSPOSE ACE AND THIS IS DATA 2236 01:20:55,897 --> 01:20:57,666 FROM ALEX'S GROUP IN WHICH THEY 2237 01:20:57,666 --> 01:21:00,936 SHOWED IN A MOUSE MODEL THAT 2238 01:21:00,936 --> 01:21:03,805 PGBD5 IS NECESSARY FOR THE 2239 01:21:03,805 --> 01:21:07,809 CREATION OF SMALL DELETION IN 2240 01:21:07,809 --> 01:21:09,211 NEURONS AND MAY LEAD TO 2241 01:21:09,211 --> 01:21:10,412 STRUCTURAL VARIATIONS BEING 2242 01:21:10,412 --> 01:21:16,151 PRESENT IN THOSE NEURONS. 2243 01:21:16,151 --> 01:21:17,719 THIS BEGS AN INTERESTING 2244 01:21:17,719 --> 01:21:19,354 QUESTION -- WE KNOW THAT THE 2245 01:21:19,354 --> 01:21:21,823 MUTATION IN THE EFFECTED 2246 01:21:21,823 --> 01:21:23,458 PATIENTS ACTUALLY LEADS TO A 2247 01:21:23,458 --> 01:21:26,762 COMPLETE LOSS OF PGD B5. 2248 01:21:26,762 --> 01:21:29,498 SO WHY WOULD A GENE THAT CAUSE 2249 01:21:29,498 --> 01:21:31,433 GENOMIC INSTABILITY IN THIS CASE 2250 01:21:31,433 --> 01:21:34,569 BE IMPORTANT FOR NORMAL BRAIN 2251 01:21:34,569 --> 01:21:35,103 DEVELOPMENT? 2252 01:21:35,103 --> 01:21:37,372 WE DON'T HAVE THE COMPLETE 2253 01:21:37,372 --> 01:21:37,806 ANSWER. 2254 01:21:37,806 --> 01:21:39,841 BUT THE DATA WE HAVE SO FAR IS 2255 01:21:39,841 --> 01:21:41,877 QUITE INTERESTING. 2256 01:21:41,877 --> 01:21:44,246 WE KNOW FROM YEARS OF RESEARCH, 2257 01:21:44,246 --> 01:21:47,582 THAT DURING THE COUR COURSE OF 2258 01:21:47,582 --> 01:21:49,484 DEVELOPMENT DEVELOPMENT IN THE 2259 01:21:49,484 --> 01:21:51,353 HUMAN BRAIN AND OTHER HIGH 2260 01:21:51,353 --> 01:21:53,955 UKRAINIANS IT WAVES THE ARE 2261 01:21:53,955 --> 01:21:56,925 NORMAL AND WE KNOW THAT THESE 2262 01:21:56,925 --> 01:21:59,127 WAVES OCCUR DESIGNATED TIMES AND 2263 01:21:59,127 --> 01:22:01,830 THE REASONS FOR THESE WAVES OF 2264 01:22:01,830 --> 01:22:04,166 PROGRAMS CELL DEN HAS NOT BEEN 2265 01:22:04,166 --> 01:22:04,866 SO CLEAR. 2266 01:22:04,866 --> 01:22:07,135 THE DATA THAT WE HAVE SO FAR, 2267 01:22:07,135 --> 01:22:10,439 SUGGESTS THAT PGBD5 MAY ACTUALLY 2268 01:22:10,439 --> 01:22:16,111 MEDIATE SOME OF THE NORMAL 2269 01:22:16,111 --> 01:22:19,781 GENOMIC VARIABILITY IN ORDER TO 2270 01:22:19,781 --> 01:22:20,615 CREATE DIFFERENT CLONES OF 2271 01:22:20,615 --> 01:22:22,784 GENOMICS AND ESSENTIALLY, 2272 01:22:22,784 --> 01:22:25,387 ENSURING THAT A GENETIC LEVEL, 2273 01:22:25,387 --> 01:22:27,088 NEURONS SHOW A SUBSTANTIAL 2274 01:22:27,088 --> 01:22:28,657 AMOUNT OF VARIABILITY. 2275 01:22:28,657 --> 01:22:30,826 THE HYPOTHESIZED THAT THIS 2276 01:22:30,826 --> 01:22:33,395 VARIABILITY MAY ACTUALLY SET THE 2277 01:22:33,395 --> 01:22:35,564 STAGE FOR BRAIN MICRO EVOLUTION 2278 01:22:35,564 --> 01:22:37,999 AND ALLOW THAT NEURAL NETWORKS 2279 01:22:37,999 --> 01:22:40,035 THAT THE MOST APPROPRIATELY 2280 01:22:40,035 --> 01:22:41,336 MATCHED TO THE ENVIRONMENT'S 2281 01:22:41,336 --> 01:22:43,705 DEMANDS TO BE MAINTAINED, WHILE 2282 01:22:43,705 --> 01:22:46,174 THOSE NEURONS THAT HAVE LESS 2283 01:22:46,174 --> 01:22:47,876 EFFECTIVE GENOMES THAT ARE LESS 2284 01:22:47,876 --> 01:22:50,545 MATCHED TO THE NEEDS OF THE 2285 01:22:50,545 --> 01:22:52,214 ORGANISM, MAY BE PRUDENT. 2286 01:22:52,214 --> 01:22:56,451 SO THIS IS A FASCINATING AREA 2287 01:22:56,451 --> 01:22:57,752 THAT WILL REQUIRE FURTHER STUDY 2288 01:22:57,752 --> 01:23:00,622 IN ORDER TO GET TO THE BOTTOM OF 2289 01:23:00,622 --> 01:23:01,590 IT. 2290 01:23:01,590 --> 01:23:02,991 ADDITIONAL STUDIES BEING 2291 01:23:02,991 --> 01:23:05,093 CONDUCTED BY SARAH LEWIS IN MY 2292 01:23:05,093 --> 01:23:06,895 LAB ARE LOOKING AT SOME OF THE 2293 01:23:06,895 --> 01:23:08,196 FUNDAMENTAL PATHWAYS THAT LEAD 2294 01:23:08,196 --> 01:23:09,998 TO CP AND ASKING THE QUESTION 2295 01:23:09,998 --> 01:23:12,601 WHETHER THESE ARE CAUSE OR 2296 01:23:12,601 --> 01:23:13,001 CONSEQUENCE. 2297 01:23:13,001 --> 01:23:15,103 AND IN PARTICULAR, SER A HAS 2298 01:23:15,103 --> 01:23:16,872 BEEN INTRIGUED BY A PATHWAY 2299 01:23:16,872 --> 01:23:21,042 CALLED EIF2 ALPHA FORMATION AND 2300 01:23:21,042 --> 01:23:22,777 THIS PATHWAY SERVES AS AN 2301 01:23:22,777 --> 01:23:25,313 IMPORTANT MEDIATOR OF STRESS 2302 01:23:25,313 --> 01:23:26,248 RESPONSES. 2303 01:23:26,248 --> 01:23:29,684 SARAH WAS INTERESTED IN EAF WHEN 2304 01:23:29,684 --> 01:23:32,921 SHE FOUND THAT IN FLY MODELS, SO 2305 01:23:32,921 --> 01:23:34,789 THESE WERE GENETIC MODEL OF THE 2306 01:23:34,789 --> 01:23:36,091 GENES THAT WE'RE FINDING IN 2307 01:23:36,091 --> 01:23:41,863 HUMAN PATIENTS, THAT EIF2 ALPHA, 2308 01:23:41,863 --> 01:23:43,965 WAS INSISTENTLY INCREASED. 2309 01:23:43,965 --> 01:23:46,067 AND THIS INDICATED A CHRONIC 2310 01:23:46,067 --> 01:23:47,869 ACTIVATION OF THE INTEGRATED 2311 01:23:47,869 --> 01:23:50,939 STRESS RESPONSE A AXIS. 2312 01:23:50,939 --> 01:23:55,310 THE GENETIC ALLYION WAS LEANING 2313 01:23:55,310 --> 01:23:56,578 TO THIS AND THE QUESTION WAS 2314 01:23:56,578 --> 01:23:58,580 WHETHER THIS WAS CAUSE OR 2315 01:23:58,580 --> 01:24:00,549 CONSEQUENCE OF THE MOTOR 2316 01:24:00,549 --> 01:24:01,983 PHENOTYPES THAT SHE WAS SEEING. 2317 01:24:01,983 --> 01:24:06,121 SHE PERFORMED EXPERIMENTS AND 2318 01:24:06,121 --> 01:24:10,458 EITHER KNOCKED OUT THE PHOSPHO 2319 01:24:10,458 --> 01:24:14,930 TASE OR OVER PRESSED THE KINASE 2320 01:24:14,930 --> 01:24:20,735 AND INDEPENDENTLY INCREASING A 2321 01:24:20,735 --> 01:24:21,269 EIF2A-P. 2322 01:24:21,269 --> 01:24:24,005 SARAH WAS ABLE TO SHOW WITH 2323 01:24:24,005 --> 01:24:26,708 THESE STUDIES WAS LOCOMOTION WAS 2324 01:24:26,708 --> 01:24:29,077 DECREASED AND IMPAIRED SO 2325 01:24:29,077 --> 01:24:32,814 ESSENTIALLY, ANIMALS THAT HAVE 2326 01:24:32,814 --> 01:24:36,851 INCREASED EIF2A-P THIS IS 2327 01:24:36,851 --> 01:24:38,186 NECESSARY AND SUFFICIENT FOR 2328 01:24:38,186 --> 01:24:41,122 THEM TO HAVE A LOCATE OWE MOTOR 2329 01:24:41,122 --> 01:24:41,957 IMPAIRMENTS. 2330 01:24:41,957 --> 01:24:42,791 FURTHERMORE, ALTHOUGH THIS IS 2331 01:24:42,791 --> 01:24:44,459 STILL SOMETHING BEING ACTIVELY 2332 01:24:44,459 --> 01:24:47,062 STUDIED IN THE LAB, THE EFFECTED 2333 01:24:47,062 --> 01:24:49,197 ANIMALS ALSO EXHIBITED DIS 2334 01:24:49,197 --> 01:24:51,933 KINETIC MOVEMENTS AND THIS 2335 01:24:51,933 --> 01:24:56,304 SUGGESTED TO US THAT EI F2A, MAY 2336 01:24:56,304 --> 01:25:00,442 BE A IMPORTANT CONVERGING 2337 01:25:00,442 --> 01:25:01,910 PATHWAY FOR CEREBRAL PALSY. 2338 01:25:01,910 --> 01:25:03,712 SARAH LOOKED FURTHER AT THE 2339 01:25:03,712 --> 01:25:06,982 INTEGRATED STRESS RESPONSE 2340 01:25:06,982 --> 01:25:10,251 PATHWAY AND HER QUESTIONS FOCUS 2341 01:25:10,251 --> 01:25:10,986 AROUND GENE ENVIRONMENT 2342 01:25:10,986 --> 01:25:13,488 INTERACTIONS SO LOOKING AT A 2343 01:25:13,488 --> 01:25:17,525 PARTICULAR FLY MODEL, SHOWING 2344 01:25:17,525 --> 01:25:20,695 MUTATIONS IN THE A GAP 1 GENE, 2345 01:25:20,695 --> 01:25:22,831 WHAT SARAH WAS ABLE TO SHOW WAS 2346 01:25:22,831 --> 01:25:24,933 THAT MUTANT FLIES, HERE DEPICTED 2347 01:25:24,933 --> 01:25:27,435 IN YELLOW, HAVE INCREASED 2348 01:25:27,435 --> 01:25:31,006 PHOSPHORYLATION OF EIF2 ALPHA IN 2349 01:25:31,006 --> 01:25:33,808 SPABASELINE, HOWEVER, IF THOSE 2350 01:25:33,808 --> 01:25:35,343 ANIMALS ARE CHALLENGED WITH AN 2351 01:25:35,343 --> 01:25:37,779 ENVIRONMENTAL STRESSOR, IN THIS 2352 01:25:37,779 --> 01:25:38,713 CASE, STARVATION, THEY WERE 2353 01:25:38,713 --> 01:25:40,615 UNABLE TO RESPOND FURTHER TO A 2354 01:25:40,615 --> 01:25:41,116 SECOND HIT. 2355 01:25:41,116 --> 01:25:43,785 IN THE WAY THAT NORMAL CONTROLS 2356 01:25:43,785 --> 01:25:44,052 DID. 2357 01:25:44,052 --> 01:25:46,187 THIS WAS QUITE INTERESTING 2358 01:25:46,187 --> 01:25:48,256 BECAUSE THIS SUGGESTED THAT 2359 01:25:48,256 --> 01:25:52,027 THERE WAS A LIMIT TO THE AMOUNT 2360 01:25:52,027 --> 01:25:53,428 OF STREETS OR ISR ACTIVATION 2361 01:25:53,428 --> 01:25:57,766 THAT ANIMALS COULD EXHIBIT. 2362 01:25:57,766 --> 01:26:00,568 AND SO SARAH LOOKED IN FOLLOW-UP 2363 01:26:00,568 --> 01:26:02,137 STUDIES AT A CHALLENGE WHICH 2364 01:26:02,137 --> 01:26:04,205 INDUCES ER STRESS, QUITE 2365 01:26:04,205 --> 01:26:05,740 INTRIGUINGLY SHE FOUND THAT 2366 01:26:05,740 --> 01:26:06,808 MUTANT FLIES BEGAN HERE IN THE 2367 01:26:06,808 --> 01:26:08,476 YELLOW SHOWED INCREASED 2368 01:26:08,476 --> 01:26:09,978 MORTALITY WHEN CHALLENGED WITH 2369 01:26:09,978 --> 01:26:12,914 THIS PARTICULAR STRESSOR 2370 01:26:12,914 --> 01:26:13,782 DEMONSTRATING GENE BY 2371 01:26:13,782 --> 01:26:15,517 ENVIRONMENT INTERACTION. 2372 01:26:15,517 --> 01:26:18,586 WE DON'T KNOW HOW WIDESPREAD 2373 01:26:18,586 --> 01:26:22,824 THIS ACTIVATION OF EIF2A IS BUT 2374 01:26:22,824 --> 01:26:27,328 IT'S REPRESENTED AN INTRIGUED 2375 01:26:27,328 --> 01:26:29,464 MODEL FOR FACTORS THAT EFFECT 2376 01:26:29,464 --> 01:26:32,267 OUTCOME IN CEREBRAL PALSY. 2377 01:26:32,267 --> 01:26:33,702 SO FOLLOW-UP QUESTION IS WHAT DO 2378 01:26:33,702 --> 01:26:39,074 WE STILL NEED TO LEARN? 2379 01:26:39,074 --> 01:26:41,576 I THINK THAT THERE'S A GENERAL 2380 01:26:41,576 --> 01:26:42,610 RECOGNITION THAT WE HAVE A NEED 2381 01:26:42,610 --> 01:26:44,145 FOR DIVERSITY. 2382 01:26:44,145 --> 01:26:45,346 THIS IS SOMETHING THE NIH 2383 01:26:45,346 --> 01:26:47,015 RECOGNIZES IN THEIR CURRENT 2384 01:26:47,015 --> 01:26:47,315 PRIORITIES. 2385 01:26:47,315 --> 01:26:50,552 IN A RESEARCH CONTEXT, IN THE CP 2386 01:26:50,552 --> 01:26:52,487 CONTEXT, WE NEED LARGER COHORTS 2387 01:26:52,487 --> 01:26:54,022 FROM DIVERSE BACKGROUNDS 2388 01:26:54,022 --> 01:26:55,156 PARTICULARLY BECAUSE MOST OF THE 2389 01:26:55,156 --> 01:26:56,725 INDIVIDUALS THAT HAVE BEEN 2390 01:26:56,725 --> 01:26:58,960 SEQUENCED SO FAR HAVE BEEN OF 2391 01:26:58,960 --> 01:27:00,495 EUROPEAN ANCESTRY AND THESE ARE 2392 01:27:00,495 --> 01:27:03,398 SHOWN US THE DE NOVO MUTATIONS 2393 01:27:03,398 --> 01:27:05,500 ARE IMPORTANT FOR CEREBRAL PALSY 2394 01:27:05,500 --> 01:27:07,435 BIOLOGY BUT YET UNPUBLISHED DATA 2395 01:27:07,435 --> 01:27:09,104 FROM NORTH AFRICA AND MIDDLE 2396 01:27:09,104 --> 01:27:11,039 EASTERN AND SOUTH EACH ASIAN 2397 01:27:11,039 --> 01:27:12,941 POPULATIONS IS ALSO STARTING TO 2398 01:27:12,941 --> 01:27:14,843 DEMONSTRATE THAT RECESSIVE 2399 01:27:14,843 --> 01:27:18,446 MODELS OF INHERENT WITH 2400 01:27:18,446 --> 01:27:19,848 DIFFERENT GENES AND PATHWAYS 2401 01:27:19,848 --> 01:27:21,049 IDENTIFY TO THESE STUDIES WILL 2402 01:27:21,049 --> 01:27:23,184 PROVE TO BE IMPORTANT SUCH THAT 2403 01:27:23,184 --> 01:27:26,154 STUDIES LED TO THE PGBD5 STROLL 2404 01:27:26,154 --> 01:27:27,322 THAT IS DEVELOPING. 2405 01:27:27,322 --> 01:27:28,289 I THINK THERE'S AN AGREEMENT IN 2406 01:27:28,289 --> 01:27:30,425 THE FIELD THAT WE NEED MORE 2407 01:27:30,425 --> 01:27:32,894 COMPREHENSIVE VARIANT ANALYSIS 2408 01:27:32,894 --> 01:27:34,329 AND THIS WILL BE POSSIBLE IN 2409 01:27:34,329 --> 01:27:36,364 PART THROUGH THE APPLICATION OF 2410 01:27:36,364 --> 01:27:38,833 WHOLE GENOME SEQUENCING IN 2411 01:27:38,833 --> 01:27:40,335 ADDITION TO EXCELLENT SEQUENCING 2412 01:27:40,335 --> 01:27:42,337 WITH ANALYSIS OF NON CODING 2413 01:27:42,337 --> 01:27:44,339 REGIONS, COPY NUMBER VARIANTS, 2414 01:27:44,339 --> 01:27:46,374 STRUCTURAL VARIANTS, REPEAT 2415 01:27:46,374 --> 01:27:47,308 EXPANSIONS AND OTHER TYPES OF 2416 01:27:47,308 --> 01:27:49,644 VARIANTS THAT HAVE NOT YET BEEN 2417 01:27:49,644 --> 01:27:51,646 COMPREHENSIVELY ASSESSED IN CP. 2418 01:27:51,646 --> 01:27:54,582 THERE'S A NEED FOR ROBUST META 2419 01:27:54,582 --> 01:27:56,017 ANALYSIS OUTLINES. 2420 01:27:56,017 --> 01:27:56,985 POTENTIALLY USING APPROACHES 2421 01:27:56,985 --> 01:27:59,888 LIKE TATA THAT COMBINE MULTIPLE 2422 01:27:59,888 --> 01:28:01,256 MODES OF INHER TANTS AND A NEED 2423 01:28:01,256 --> 01:28:03,224 TO ATTRACT ADDITIONAL 2424 01:28:03,224 --> 01:28:05,927 COMPUTATIONAL BIOLOGY TALENT TO 2425 01:28:05,927 --> 01:28:06,594 THE FIELD. 2426 01:28:06,594 --> 01:28:08,263 WE HAVE A NEED FOR MORE COMPLEX 2427 01:28:08,263 --> 01:28:10,999 STUDY DESIGNS OVER TIME. 2428 01:28:10,999 --> 01:28:13,401 ALLOWING US TO LOOK AT POLYGENIC 2429 01:28:13,401 --> 01:28:15,537 CONTRIBUTIONS, GENE BY GENE 2430 01:28:15,537 --> 01:28:16,738 INTERACTIONS AND ALSO GENE 2431 01:28:16,738 --> 01:28:21,276 ENVIRONMENT INTERACTIONS. 2432 01:28:21,276 --> 01:28:22,343 FINALLY, WHERE DO WE GO FROM 2433 01:28:22,343 --> 01:28:22,911 HERE? 2434 01:28:22,911 --> 01:28:24,813 I THINK THERE'S A AGREEMENT ALSO 2435 01:28:24,813 --> 01:28:28,650 THAT THERE IS A HUGE NEED FOR 2436 01:28:28,650 --> 01:28:30,084 COLLABORATION AND COLLABORATIVE 2437 01:28:30,084 --> 01:28:30,351 NETWORKS. 2438 01:28:30,351 --> 01:28:32,554 WE'VE BEEN EXCITED BY THE 2439 01:28:32,554 --> 01:28:34,088 OPPORTUNITY TO DEVELOP AND 2440 01:28:34,088 --> 01:28:35,857 EMPLOY PARTICIPANT FACING TOOLS. 2441 01:28:35,857 --> 01:28:39,160 FOR EXAMPLE, WE'VE DEVELOPED AN 2442 01:28:39,160 --> 01:28:40,395 IOS-BASED I CONSENT APPLICATION 2443 01:28:40,395 --> 01:28:42,430 THAT IS FULLY SELF ENCLOSED AND 2444 01:28:42,430 --> 01:28:45,233 THIS ALLOWS POTENTIALLY 2445 01:28:45,233 --> 01:28:47,502 INTERESTED FAMILIES TO INTERACT 2446 01:28:47,502 --> 01:28:48,870 DIRECTLY WITH THE APP TO LEARN 2447 01:28:48,870 --> 01:28:51,072 MORE ABOUT OUR STUDIES AND TO 2448 01:28:51,072 --> 01:28:53,274 ENROLL THEMSELVES IF THEY'RE 2449 01:28:53,274 --> 01:28:53,842 INTERESTED. 2450 01:28:53,842 --> 01:28:56,077 WITHIN A COMPLETELY SELF 2451 01:28:56,077 --> 01:28:58,213 CONTAINED ELECTRONIC 2452 01:28:58,213 --> 01:28:58,580 ENVIRONMENT. 2453 01:28:58,580 --> 01:29:00,949 THIS WILL ALLOW US TO REACH MORE 2454 01:29:00,949 --> 01:29:02,483 FAMILIES AND ENGAGE MORE PEOPLE 2455 01:29:02,483 --> 01:29:04,519 IN THIS TYPE OF RESEARCH. 2456 01:29:04,519 --> 01:29:05,787 I THINK THERE'S CERTAINLY 2457 01:29:05,787 --> 01:29:09,090 EXCITING POSSIBILITIES FOR 2458 01:29:09,090 --> 01:29:13,094 PRECISION PHENOMICS AND A MULTI 2459 01:29:13,094 --> 01:29:14,829 DIMENSIONAL CHARACTERIZATION OF 2460 01:29:14,829 --> 01:29:17,298 CP AND FOR NEXT-GEN OUTCOMES 2461 01:29:17,298 --> 01:29:17,665 RESEARCH. 2462 01:29:17,665 --> 01:29:19,434 WE THINK THERE ARE OPPORTUNITIES 2463 01:29:19,434 --> 01:29:22,871 FOR CLINICAL DATA MINING AND 2464 01:29:22,871 --> 01:29:25,206 FROM ELECTRONIC MEDICAL RECORDS, 2465 01:29:25,206 --> 01:29:27,842 BUT ALSO INCLUDING NEUROIMAGING, 2466 01:29:27,842 --> 01:29:29,644 POTENTIALLY INCLUDING FACIAL 2467 01:29:29,644 --> 01:29:33,948 PHOTOS, PATIENT VIDEOS AND NEURO 2468 01:29:33,948 --> 01:29:37,819 PHYSIOLOGY TO DEFINE PATIENT 2469 01:29:37,819 --> 01:29:39,587 PHENOTYPES AND GENE PHENOTYPE 2470 01:29:39,587 --> 01:29:41,055 INTERACTIONS AND THERE'S A NEED 2471 01:29:41,055 --> 01:29:45,560 FOR RISK FACTORS ASSESSMENT. 2472 01:29:45,560 --> 01:29:46,961 I THINK AGAIN THERE ARE 2473 01:29:46,961 --> 01:29:47,795 TREMENDOUS OPPORTUNITIES FOR 2474 01:29:47,795 --> 01:29:50,632 THIS IN CP. 2475 01:29:50,632 --> 01:29:52,967 FINALLY I SHALL THERE'S AN 2476 01:29:52,967 --> 01:29:54,469 INCREASINGLY ROLE FOR TRIALS AND 2477 01:29:54,469 --> 01:29:56,838 IF PROPERLY DESIGNED AND 2478 01:29:56,838 --> 01:29:58,273 CONDUCTED, SUCH STUDIES CAN 2479 01:29:58,273 --> 01:30:00,508 PROVE TO BE VERY INFORMATIVE AS 2480 01:30:00,508 --> 01:30:01,910 WE LOOK FOR BETTER TREATMENTS 2481 01:30:01,910 --> 01:30:04,178 FOR GENETIC FORMS OF CP AND FOR 2482 01:30:04,178 --> 01:30:07,282 CP IN GENERAL. 2483 01:30:07,282 --> 01:30:09,417 SO WITH THAT I'LL CONCLUDE. 2484 01:30:09,417 --> 01:30:11,519 BUT I HAVE TO GIVE A HEARTY 2485 01:30:11,519 --> 01:30:13,988 THANKS TO MY AMAZING LAB. 2486 01:30:13,988 --> 01:30:16,457 OUR MANY FANTASTIC COLLABORATORS 2487 01:30:16,457 --> 01:30:18,593 AND SUPPORTING ORGANIZATIONS. 2488 01:30:18,593 --> 01:30:20,228 AND OF COURSE MY WONDERFUL 2489 01:30:20,228 --> 01:30:20,561 FAMILY. 2490 01:30:20,561 --> 01:30:22,030 WITHOUT WHOM I WOULD NOT BE 2491 01:30:22,030 --> 01:30:22,230 HERE. 2492 01:30:22,230 --> 01:30:26,134 THANK YOU, VERY MUCH. 2493 01:30:26,134 --> 01:30:28,369 >> GOOD AFTERNOON, MY NAME IS 2494 01:30:28,369 --> 01:30:30,204 NEHAL PARIKH AND TODAY I WILL 2495 01:30:30,204 --> 01:30:32,106 PRESENT EARLY DIAGNOSIS OF 2496 01:30:32,106 --> 01:30:33,675 PERINATAL BRAIN INJURY OR 2497 01:30:33,675 --> 01:30:35,810 DELAYED BRAIN MATURATION AND 2498 01:30:35,810 --> 01:30:37,011 PREDICTION OF CEREBRAL PALSY. 2499 01:30:37,011 --> 01:30:40,214 I HAVE NO CONFLICTS TO DISCLOSE. 2500 01:30:40,214 --> 01:30:42,784 I WILL TRY TO PRESENT THE MOST 2501 01:30:42,784 --> 01:30:46,454 COMMON BRAIN ABNORMALITIES AND 2502 01:30:46,454 --> 01:30:47,855 BRAIN PREDICTION OF CP. 2503 01:30:47,855 --> 01:30:49,757 WE'LL GO OVER ENHANCING 2504 01:30:49,757 --> 01:30:53,394 PROGNOSIS WITH ADVANCED MRI. 2505 01:30:53,394 --> 01:30:55,296 I WILL BRIEFLY DISCUSS THE ADDED 2506 01:30:55,296 --> 01:30:56,597 VALUE OF EARLY FUNCTIONAL 2507 01:30:56,597 --> 01:30:58,733 TESTING AT THREE TO FOUR MONTHS 2508 01:30:58,733 --> 01:31:00,835 CORRECTED AGE SUCH AS THE 2509 01:31:00,835 --> 01:31:01,769 NEUROLOGICAL EXAM AND THE 2510 01:31:01,769 --> 01:31:03,905 GENERAL MOVEMENT ASSESSMENT AND 2511 01:31:03,905 --> 01:31:06,607 WE'LL WRAP THINGS UP WITH 2512 01:31:06,607 --> 01:31:09,177 CONTINUED GAPS IN OUR NOM AND WE 2513 01:31:09,177 --> 01:31:11,913 CAN GO NEXT TO APPROVE EARLY 2514 01:31:11,913 --> 01:31:13,448 DIAGNOSIS AND PREDICTION OF CP. 2515 01:31:13,448 --> 01:31:15,483 THERE'S CONSENSUS THAT CP IS 2516 01:31:15,483 --> 01:31:18,319 CAUSED BY EARLY BRAIN INJURY OR 2517 01:31:18,319 --> 01:31:21,856 BRAIN MALL FORMATIONS. 2518 01:31:21,856 --> 01:31:24,058 HOWEVER, NEUROIMAGING IS NORMAL 2519 01:31:24,058 --> 01:31:26,427 UP TO 30% CASES OF CP. 2520 01:31:26,427 --> 01:31:29,731 WHY THAT BIG GAP IN DIAGNOSIS? 2521 01:31:29,731 --> 01:31:31,399 WELL, I BELIEVE THERE ARE THREE 2522 01:31:31,399 --> 01:31:33,067 KEY ADVANCEMENT THAT'S CAN HELP 2523 01:31:33,067 --> 01:31:33,801 CLOSE THAT GAP. 2524 01:31:33,801 --> 01:31:36,637 ONE IS TO ENABLE BETTER 2525 01:31:36,637 --> 01:31:37,805 UNDERSTANDING AND KNOWLEDGE OF 2526 01:31:37,805 --> 01:31:39,941 DIFFERENT TYPES OF PERINATAL 2527 01:31:39,941 --> 01:31:40,742 BRAIN INJURIES. 2528 01:31:40,742 --> 01:31:43,678 WE ALSO NEED TO TRANSITION FROM 2529 01:31:43,678 --> 01:31:45,079 SUBJECTIVE TO OBJECTIVE METHODS 2530 01:31:45,079 --> 01:31:47,548 TO DIAGNOSE INJURY AND IF WE 2531 01:31:47,548 --> 01:31:49,951 EMPLOY MORE SENSITIVE ADVANCED 2532 01:31:49,951 --> 01:31:52,920 MRI MODALITY SUCH AS FUNCTIONAL 2533 01:31:52,920 --> 01:31:57,458 MRI WE WILL CLOSE THAT GAP. 2534 01:31:57,458 --> 01:32:02,463 AND NEONATAL OR CIE, PRE TERM 2535 01:32:02,463 --> 01:32:05,166 INFANTS HAVE A COMBINATION OF 2536 01:32:05,166 --> 01:32:07,335 SEVERAL TYPES OF BRAIN INJURIES 2537 01:32:07,335 --> 01:32:10,038 AND BRAIN IMMATURE TEE THAT 2538 01:32:10,038 --> 01:32:11,939 RESULTS IN NEURO DEVELOPMENTAL 2539 01:32:11,939 --> 01:32:22,383 IMPAIRMENTS INCLUDING CP. 2540 01:32:22,583 --> 01:32:26,921 INCLUDING FOR HEMORRHAGE AND 2541 01:32:26,921 --> 01:32:28,056 LEUKOMALACIA BUT THANKS TO 2542 01:32:28,056 --> 01:32:30,058 ADVANCES IN NEO IN AAL CARE WE 2543 01:32:30,058 --> 01:32:34,062 HAVE REDUCED THESE COMMON 2544 01:32:34,062 --> 01:32:35,696 ABNORMALITIES AND WITH 2545 01:32:35,696 --> 01:32:37,732 INCREASING USE OF BRAIN MRI AT 2546 01:32:37,732 --> 01:32:41,736 TERM, WE'RE SEEING MORE SUBTLE 2547 01:32:41,736 --> 01:32:44,906 DIFFUSE INJURIES AND DELAYS THAT 2548 01:32:44,906 --> 01:32:47,275 MAY BE PREDICTORS OF CP. 2549 01:32:47,275 --> 01:32:48,943 DELAYS IN WHITE MATTER AND 2550 01:32:48,943 --> 01:32:50,912 CORTICAL GRAY MATTER MAT 2551 01:32:50,912 --> 01:33:01,055 YOU'MAT MATURATION ANDSO ARE WHD 2552 01:33:01,055 --> 01:33:01,656 THE 2553 01:33:01,656 --> 01:33:04,258 USE EXCESSIVE HIGH SIGNAL 2554 01:33:04,258 --> 01:33:06,861 INTENSITY ABNORMALITY AND MY 2555 01:33:06,861 --> 01:33:09,664 GROUPS CAUSED WHITE MATTER 2556 01:33:09,664 --> 01:33:10,932 ABNORMALITY WHEN WE CAN QUANTIFY 2557 01:33:10,932 --> 01:33:11,199 IT. 2558 01:33:11,199 --> 01:33:13,334 IN ONE STUDY WE DID 16% OF 2559 01:33:13,334 --> 01:33:14,735 BABIES BORN LESS THAN A THOUSAND 2560 01:33:14,735 --> 01:33:17,772 GRAMS OR EXTREMELY WILL HE BIRTH 2561 01:33:17,772 --> 01:33:21,742 WAY EXHIBITED MODERATE TO SEVERE 2562 01:33:21,742 --> 01:33:22,944 DELAYED MATURATION AND YOU SEE 2563 01:33:22,944 --> 01:33:25,046 IT HERE IN A PRE TERM INFANT 2564 01:33:25,046 --> 01:33:29,150 IMAGE AT 40 WEEKS YOU CAN SEE 2565 01:33:29,150 --> 01:33:31,319 THE GYRAL ARE UNDER DEVELOPED 2566 01:33:31,319 --> 01:33:33,287 AND SMOOTH AND COMPARED TO A PRE 2567 01:33:33,287 --> 01:33:35,456 TERM INFANT IMAGE AT 40 WEEKS 2568 01:33:35,456 --> 01:33:37,191 WHERE THERE ARE NO DELAYS IN THE 2569 01:33:37,191 --> 01:33:39,660 LOWER IMAGE WHERE YOU CAN SEE 2570 01:33:39,660 --> 01:33:44,832 MUCH MORE DETAILED AND DEEPER 2571 01:33:44,832 --> 01:33:48,169 CELL AND MORE GYRAY. 2572 01:33:48,169 --> 01:33:53,074 WE CAN USE AUTOMATE MODES AS 2573 01:33:53,074 --> 01:33:53,274 WELL. 2574 01:33:53,274 --> 01:33:55,676 AT LEAST USING SUBJECTIVE 2575 01:33:55,676 --> 01:33:56,944 ASSESSMENT IT WAS NOT PREDICTIVE 2576 01:33:56,944 --> 01:34:01,849 OF MOTOR DEVELOPMENT AND IT WAS 2577 01:34:01,849 --> 01:34:03,985 PREDICTIVE OF COGNITIVE 2578 01:34:03,985 --> 01:34:04,552 DEVELOPMENT. 2579 01:34:04,552 --> 01:34:07,421 WE EXAMINED THIS MORE OBJECTIVE 2580 01:34:07,421 --> 01:34:10,725 MEANS OF MEASUREMENT USING 2581 01:34:10,725 --> 01:34:11,893 AUTOMATED PIPELINE AND WE 2582 01:34:11,893 --> 01:34:14,896 STUDIED A REGIONAL COHORT OF 395 2583 01:34:14,896 --> 01:34:17,498 PRE TERM INFANTS BOTH IN 2584 01:34:17,498 --> 01:34:18,933 SOUTHWEST OHIO AND WE CALLED 2585 01:34:18,933 --> 01:34:22,570 THIS COHORT THE SYNAPSE COHORT 2586 01:34:22,570 --> 01:34:24,372 OR EARLY PREDICTION STUDY AND 2587 01:34:24,372 --> 01:34:26,741 THESE FOUR MEASURES INCLUDED 2588 01:34:26,741 --> 01:34:30,878 SURFACE AREA, GENERAL INDEX, 2589 01:34:30,878 --> 01:34:31,412 DEPTH AND INTER CORTICAL 2590 01:34:31,412 --> 01:34:32,680 CURVATURE AND UNFORTUNATELY NONE 2591 01:34:32,680 --> 01:34:38,219 OF THESE WERE PREDICT PREDICTIV. 2592 01:34:38,219 --> 01:34:39,487 THERE'S AN ASSOCIATION OF 2593 01:34:39,487 --> 01:34:39,987 COGNITION AND LANGUAGE 2594 01:34:39,987 --> 01:34:42,657 DEVELOPMENT BUT NOT WITH 2595 01:34:42,657 --> 01:34:44,892 CEREBRAL PALSY. 2596 01:34:44,892 --> 01:34:46,561 WHAT ABOUT WHITE MATTER LESIONS? 2597 01:34:46,561 --> 01:34:48,930 THESE ARE SEEN BETWEEN SEVEN TO 2598 01:34:48,930 --> 01:34:53,834 39% OF BABIES IN LARGE COHORTS. 2599 01:34:53,834 --> 01:34:57,572 YOU CAN SEE HERE ON T2 OR SORRY 2600 01:34:57,572 --> 01:35:01,075 T1 WEIGHTED IMAGING, THIS BRIGHT 2601 01:35:01,075 --> 01:35:03,344 SIGNAL ABNORMALITY THAT YOU CAN 2602 01:35:03,344 --> 01:35:05,413 SEE THERE IN A LINEAR FASHION 2603 01:35:05,413 --> 01:35:08,182 YOU CAN SEE ON IMAGES AND 2604 01:35:08,182 --> 01:35:12,753 THEY'RE ALL PERRY VENTRICULAR 2605 01:35:12,753 --> 01:35:15,456 AND THIS NICE FIGURE HERE WAS 2606 01:35:15,456 --> 01:35:17,124 LOOKING AT THE DISTRIBUTION OF 2607 01:35:17,124 --> 01:35:20,661 THESE LESIONS AND OVER 100 2608 01:35:20,661 --> 01:35:22,797 BABIES THAT WERE STUDIED OF 2609 01:35:22,797 --> 01:35:26,133 WHICH OVER 60 I BELIEVE HAD 2610 01:35:26,133 --> 01:35:27,802 LESIONS AND THE DISTRIBUTION 2611 01:35:27,802 --> 01:35:31,172 AGAIN IS VERY MUCH PEIR 2612 01:35:31,172 --> 01:35:33,507 VENTRICULAR AS CAN YOU SEE HERE 2613 01:35:33,507 --> 01:35:36,577 AT IMAGES AND ON THIS MAP YOU 2614 01:35:36,577 --> 01:35:39,313 CAN SEE THE BLUE ARE THE FINAL 2615 01:35:39,313 --> 01:35:39,547 TRACKS. 2616 01:35:39,547 --> 01:35:43,217 AND YOU CAN SEE HOW CLEARLY 2617 01:35:43,217 --> 01:35:44,285 THESE LESIONS LIE WITHIN THE 2618 01:35:44,285 --> 01:35:46,153 PATHWAY OF THE SENSORY MOTOR 2619 01:35:46,153 --> 01:35:46,721 TRACKS. 2620 01:35:46,721 --> 01:35:51,292 SO NO SURPRISE, THIS STUDY AT 2621 01:35:51,292 --> 01:35:52,627 LEAST FROM BRITISH COLUMBIA, DID 2622 01:35:52,627 --> 01:35:56,631 SEE A STRONG CORRELATION WITH 2623 01:35:56,631 --> 01:36:01,269 MOTOR ABNORMALITY AND ODDS RATIO 2624 01:36:01,269 --> 01:36:03,504 OF 29.8 AND A LARGE STUDY IN THE 2625 01:36:03,504 --> 01:36:05,273 U.K. OF PRE TERM INFANTS DID NOT 2626 01:36:05,273 --> 01:36:08,109 SEE AN ASSOCIATION. 2627 01:36:08,109 --> 01:36:09,844 SO THIS LESIONS ARE STILL SOME 2628 01:36:09,844 --> 01:36:11,545 ADDITIONAL WORK THAT NEEDS TO BE 2629 01:36:11,545 --> 01:36:11,912 DONE. 2630 01:36:11,912 --> 01:36:17,184 WHAT WE DID TO GET AT THIS TRUTH 2631 01:36:17,184 --> 01:36:20,254 WAS WE SEGMENT THESE LESIONS TO 2632 01:36:20,254 --> 01:36:22,156 GET A BETTER QUANTIFICATION 2633 01:36:22,156 --> 01:36:23,758 RATHER THAN A NUMBER OF LESIONS 2634 01:36:23,758 --> 01:36:25,326 WHICH IS WHAT OTHER INVESTIGATES 2635 01:36:25,326 --> 01:36:25,826 HAVE DONE. 2636 01:36:25,826 --> 01:36:27,361 WE SAID WE WOULD QUANTIFY THE 2637 01:36:27,361 --> 01:36:29,297 VOLUME OF THIS LESION. 2638 01:36:29,297 --> 01:36:31,932 AND WE WERE ABLE TO DO THIS WITH 2639 01:36:31,932 --> 01:36:34,435 A HIGH DEGREE OF RELIABILITY AND 2640 01:36:34,435 --> 01:36:37,705 WE DICHOTOMIZED THIS VALUE 2641 01:36:37,705 --> 01:36:39,940 BECAUSE IT'S NOT NORMALLY 2642 01:36:39,940 --> 01:36:41,709 DISTRIBUTED AND THOSE THAT HAD 2643 01:36:41,709 --> 01:36:44,045 SEVERE LESIONS DID HAVE AN 2644 01:36:44,045 --> 01:36:46,414 ELEVATED RISK OF EARLY DIAGNOSIS 2645 01:36:46,414 --> 01:36:47,515 OF CEREBRAL PALSY WITH AN ODDS 2646 01:36:47,515 --> 01:36:50,851 RATIO OF 3.5 SO THE LESIONS ARE 2647 01:36:50,851 --> 01:36:53,421 SEEN IN UP TO 30% OF PRE TERM 2648 01:36:53,421 --> 01:36:54,555 INFANTS ESPECIALLY WITH THE 2649 01:36:54,555 --> 01:36:57,658 ADVENT OF INCREASING USE OF TERM 2650 01:36:57,658 --> 01:36:59,226 MRI AND SEEING THIS MUCH MORE 2651 01:36:59,226 --> 01:37:03,531 READILY AND ULTRASOUND IS NOT 2652 01:37:03,531 --> 01:37:06,600 ALWAYS THE BEST TOOL TO USE IF U 2653 01:37:06,600 --> 01:37:09,303 ONLY INTER FON ENAL USE AND UP 2654 01:37:09,303 --> 01:37:12,306 TO 10% DEMONSTRATE SIGNIFICANCE 2655 01:37:12,306 --> 01:37:13,741 OF LESIONS MOST COMMONLY 2656 01:37:13,741 --> 01:37:16,944 HEMORRHAGES BUT ATROPHY IS ALSO 2657 01:37:16,944 --> 01:37:18,579 SEEN AS A RESULT OF THE 2658 01:37:18,579 --> 01:37:19,447 HEMORRHAGE. 2659 01:37:19,447 --> 01:37:21,115 AND THESE SIGNIFICANT LESIONS 2660 01:37:21,115 --> 01:37:23,117 ARE PREDICTIVE OF CEREBRAL 2661 01:37:23,117 --> 01:37:23,317 PALSY. 2662 01:37:23,317 --> 01:37:25,419 AT LEAST MODERN TO SEVERE 2663 01:37:25,419 --> 01:37:27,054 CEREBRAL PALSY IN SOME COHORTS 2664 01:37:27,054 --> 01:37:31,359 SUCH AS THE STUDY FROM HUGH SUSN 2665 01:37:31,359 --> 01:37:32,026 HUNDRED DOLLARS WHERE THEY SAW 2666 01:37:32,026 --> 01:37:35,329 THE RATIO OF 5.2 AND LOOKING AT 2667 01:37:35,329 --> 01:37:37,798 THE COHORT FROM U.K. AND DAVID 2668 01:37:37,798 --> 01:37:39,734 EDWARD'S GROUP THEY DID NOT SEE 2669 01:37:39,734 --> 01:37:41,669 ANY CORRELATION WITH CEREBRAL 2670 01:37:41,669 --> 01:37:41,869 PALSY. 2671 01:37:41,869 --> 01:37:45,039 ONE WAY TO IMPROVE OUR ABILITY 2672 01:37:45,039 --> 01:37:46,674 TO PREDICT CEREBRAL PALSY IS TO 2673 01:37:46,674 --> 01:37:48,209 COMBINE THESE DIFFERENT TYPES OF 2674 01:37:48,209 --> 01:37:51,078 INJURIES INTO A SINGLE SCORE, A 2675 01:37:51,078 --> 01:37:52,246 COMPOSITE SCORE OF BRAIN INJURY 2676 01:37:52,246 --> 01:37:56,283 AND MATURATION AND THIS SCORE 2677 01:37:56,283 --> 01:37:59,253 THAT THE DOCTORS PUT TOGETHER 2678 01:37:59,253 --> 01:38:01,188 ARE PREDICTED NOT ONLY OF TWO 2679 01:38:01,188 --> 01:38:03,424 OUTCOMES AND LONG-TERM NEURO 2680 01:38:03,424 --> 01:38:04,392 DEVELOPMENTAL OUTCOMES UP TO 2681 01:38:04,392 --> 01:38:05,926 SEVEN YEARS OF AGE. 2682 01:38:05,926 --> 01:38:08,195 AND THIS IS A COMPOSITE OF FOUR 2683 01:38:08,195 --> 01:38:10,097 DIFFERENT TYPES OF TISSUE, 2684 01:38:10,097 --> 01:38:11,766 CEREBELLUM, WHITE MATTER, GRAY 2685 01:38:11,766 --> 01:38:13,801 MATTER AND DEEP GRAY MATTER AND 2686 01:38:13,801 --> 01:38:16,137 BASICALLY THE CEREBELLUM SCORE 2687 01:38:16,137 --> 01:38:18,406 IS A SIGNIFICANT BUT WEAK 2688 01:38:18,406 --> 01:38:22,643 PREDICT OR OF MOTOR SCORES AT 2689 01:38:22,643 --> 01:38:25,146 SEVEN YEARS OF DAY, WE NEED MORE 2690 01:38:25,146 --> 01:38:29,216 ON CEREBELLAR LESIONS BUT IT'S 2691 01:38:29,216 --> 01:38:30,384 SOMETHING THAT IS WORTH LOOKING 2692 01:38:30,384 --> 01:38:31,585 AT MORE CLOSELY. 2693 01:38:31,585 --> 01:38:34,488 AS I MENTIONED, DIFFUSE 2694 01:38:34,488 --> 01:38:36,624 EXCESSIVE HIGH SIGNAL INTENSITY 2695 01:38:36,624 --> 01:38:37,825 ABNORMALITIES ARE OBSERVED MORE 2696 01:38:37,825 --> 01:38:39,727 COMMONLY THAN ANY OTHER LESIONS 2697 01:38:39,727 --> 01:38:45,666 AND UP TO 70% OF PRE TERM 2698 01:38:45,666 --> 01:38:50,504 INFANTS HERE WE HAVE IMAGED THE 2699 01:38:50,504 --> 01:38:55,142 42 WEEKS AND YOU CAN SEE IN THIS 2700 01:38:55,142 --> 01:38:58,212 VALUE THERE'S A BRIGHTER SIGNAL 2701 01:38:58,212 --> 01:39:01,515 THAT REPRESENTS DWMA AND IN THIS 2702 01:39:01,515 --> 01:39:05,052 CENTRAL WHITE MATTER AND IN THE 2703 01:39:05,052 --> 01:39:06,687 PERRY VENTRICULAR WHITE MATTER 2704 01:39:06,687 --> 01:39:08,956 ON THE RIGHT. 2705 01:39:08,956 --> 01:39:10,124 IT'S SUBJECTIVE AND SOME 2706 01:39:10,124 --> 01:39:16,530 RADIOLOGISTS MAY SAY THERE'S NO 2707 01:39:16,530 --> 01:39:18,532 DEHSI AND SOME MAY THERE'S NOT. 2708 01:39:18,532 --> 01:39:20,267 WE'VE BEEN WORK ON A SOFTWARE 2709 01:39:20,267 --> 01:39:24,004 FOR OVER A DECADE AID THAT HAS 2710 01:39:24,004 --> 01:39:27,408 BEEN COMPLETED AUTOMATED USING A 2711 01:39:27,408 --> 01:39:32,046 DEEP LEARNING ALGORITHM AND THE 2712 01:39:32,046 --> 01:39:33,948 SOFTWARE BELIEVES THE YELLOW ARE 2713 01:39:33,948 --> 01:39:36,650 MOST ABNORMAL AND QUANTIFIES 2714 01:39:36,650 --> 01:39:41,188 SEGMENTS AND QUANTIFIES AS DEHSI 2715 01:39:41,188 --> 01:39:42,490 OR DIFFUSE WHITE MATTER 2716 01:39:42,490 --> 01:39:43,991 ABNORMALITY AND ON THE RIGHT IS 2717 01:39:43,991 --> 01:39:48,395 A HEAT MAP OF DEHSI THAT THE 2718 01:39:48,395 --> 01:39:48,896 SOFTWARE QUANTIFIES AND 2719 01:39:48,896 --> 01:39:50,264 IDENTIFIES IN OVER 300 BABIES 2720 01:39:50,264 --> 01:39:51,799 AND YOU CAN SEE THE DISTRIBUTION 2721 01:39:51,799 --> 01:39:55,102 IS PRIMARILY PERIVENTRICULAR BUT 2722 01:39:55,102 --> 01:40:01,742 THERE'S A GOOD A LOT IN THE SUB 2723 01:40:01,742 --> 01:40:03,911 COURT CO WHITE MATTER. 2724 01:40:03,911 --> 01:40:06,714 IT'S SUBJECTIVE IN ITS 2725 01:40:06,714 --> 01:40:11,785 RELIABILITY AND RA RADIOLOGY 2726 01:40:11,785 --> 01:40:13,053 DIAGNOSIS IS POOR AND FAIR AT 2727 01:40:13,053 --> 01:40:13,454 BEST. 2728 01:40:13,454 --> 01:40:15,189 IT'S NOT ASSOCIATED WITH 2729 01:40:15,189 --> 01:40:15,556 CEREBRAL PALSY. 2730 01:40:15,556 --> 01:40:16,891 IN MULTIPLE STUDIES INCLUDING 2731 01:40:16,891 --> 01:40:19,159 TWO STUDIES THAT WE PUBLISHED. 2732 01:40:19,159 --> 01:40:23,264 HOWEVER, WHEN WE QUANTIFY IT, 2733 01:40:23,264 --> 01:40:24,131 IT'S PREDICTIVE OF CEREBRAL 2734 01:40:24,131 --> 01:40:27,868 PALSY WITH AN ODDS RATIO OF 31.6 2735 01:40:27,868 --> 01:40:30,437 AND PRO DICK TIVE OF DAILY 2736 01:40:30,437 --> 01:40:33,774 SCORES AT AGE 2 INCLUDING DAILY 2737 01:40:33,774 --> 01:40:34,842 MOTOR, COGNITIVE LANGUAGE SCORES 2738 01:40:34,842 --> 01:40:37,478 AND THIS FINDING ACTUALLY IS A 2739 01:40:37,478 --> 01:40:39,113 EXTERNAL VALIDATION OF A PRIOR 2740 01:40:39,113 --> 01:40:41,882 STUDY THAT WE DID FROM A 2741 01:40:41,882 --> 01:40:43,784 DIFFERENT COHORT THAT WE 2742 01:40:43,784 --> 01:40:46,654 PUBLISHED ALMOST 10 YEARS AGO. 2743 01:40:46,654 --> 01:40:49,356 SO, WHAT ABOUT DIFFUSION MRI I 2744 01:40:49,356 --> 01:40:51,225 MENTIONED THE NEED TO DO MORE 2745 01:40:51,225 --> 01:40:53,794 ADVANCED IMAGING TO IMPROVE THE 2746 01:40:53,794 --> 01:40:55,796 SENSITIVITY OF DETECTION OF 2747 01:40:55,796 --> 01:40:56,397 INJURIES. 2748 01:40:56,397 --> 01:40:57,264 ESPECIALLY AS THESE INJURIES 2749 01:40:57,264 --> 01:40:59,867 HAVE BECOME MORE SUBTLE AND 2750 01:40:59,867 --> 01:41:00,100 DIFFUSE. 2751 01:41:00,100 --> 01:41:05,105 SO WE LOOKED AT THE CINEPS 2752 01:41:05,105 --> 01:41:10,578 COHORT IN BABIES WHERE OBTAINING 2753 01:41:10,578 --> 01:41:11,879 MULTI-SHELL DATA WHERE WE GET 2754 01:41:11,879 --> 01:41:14,448 MULTIPLE DIRECTIONS UP TO 100 2755 01:41:14,448 --> 01:41:15,516 DIRECTIONS OF DIFFUSION DATA AND 2756 01:41:15,516 --> 01:41:20,254 THIS ALLOWS US TO MODEL THE 2757 01:41:20,254 --> 01:41:22,656 DIFFUSION OF WATER AND CREATE 2758 01:41:22,656 --> 01:41:25,025 THESE HIGHER ORDER DIFFUSION MRI 2759 01:41:25,025 --> 01:41:27,027 MODELS THAT CANNOT ONLY GET AT 2760 01:41:27,027 --> 01:41:29,029 MICRO STRUCTURE BUT ALSO MACRO 2761 01:41:29,029 --> 01:41:31,765 STRUCTURE OF WHITE MATTER 2762 01:41:31,765 --> 01:41:33,267 INTEGRITY AND WE LOOKED AT 2763 01:41:33,267 --> 01:41:34,635 SEVERAL SENSORY MOTOR TRACKS AND 2764 01:41:34,635 --> 01:41:38,105 THE MOST IMPORTANT ONCE ONCE, HE 2765 01:41:38,105 --> 01:41:41,742 YOU CAN SEE IN THIS IMAGE, 2766 01:41:41,742 --> 01:41:44,345 BILATERAL SUPERIOR RADIATIONS 2767 01:41:44,345 --> 01:41:46,246 THIS THE MOTOR COMPONENT AND C 2768 01:41:46,246 --> 01:41:50,050 IS THE SENSORY COMPONENT AND. 2769 01:41:50,050 --> 01:41:52,052 LEFT AND RIGHT. 2770 01:41:52,052 --> 01:41:57,124 AND THE YOU CAN SEE HERE VIEWS. 2771 01:41:57,124 --> 01:41:59,259 SO INTERESTINGLY, IN CHILDREN 2772 01:41:59,259 --> 01:42:02,830 THAT DEVELOP EARLY CP, ALL OF 2773 01:42:02,830 --> 01:42:04,131 THESE TRACKS WERE ABNORMALLY 2774 01:42:04,131 --> 01:42:05,532 DEVELOPED WHEN WE LOOKED AT BOTH 2775 01:42:05,532 --> 01:42:09,103 MACRO AND MICRO STRUCTURE. 2776 01:42:09,103 --> 01:42:11,005 THINGS SUCH AS FIBER CROSS 2777 01:42:11,005 --> 01:42:14,908 SECTION AND FIBER DENSITY AND WE 2778 01:42:14,908 --> 01:42:17,044 BELIEVE THAT THESE COULD BE USED 2779 01:42:17,044 --> 01:42:18,879 TO PREDICT CP. 2780 01:42:18,879 --> 01:42:20,581 THIS IS WAS ONLY AN ASSOCIATION 2781 01:42:20,581 --> 01:42:22,983 STUDY BUT WE HOPE TO ASSOCIATE 2782 01:42:22,983 --> 01:42:24,785 THIS WITH THE TRUE DIAGNOSIS OF 2783 01:42:24,785 --> 01:42:26,587 CP AT AGE 2. 2784 01:42:26,587 --> 01:42:28,922 WE DID ANOTHER STUDY IN THE 2785 01:42:28,922 --> 01:42:31,792 SYNAPSE COHORT USING DIFFUSION 2786 01:42:31,792 --> 01:42:33,127 IMAGE MODELING AND HERE WE 2787 01:42:33,127 --> 01:42:34,895 DEVELOPED A STRUCTURAL 2788 01:42:34,895 --> 01:42:36,930 CONNECTION TONE USING AND ALSO 2789 01:42:36,930 --> 01:42:39,967 CAME UP WITH RAV THEORY METRICS 2790 01:42:39,967 --> 01:42:42,670 TO UNDERSTAND BRAIN NETWORK 2791 01:42:42,670 --> 01:42:45,873 EFFICIENCY AND SEGREGATION AND 2792 01:42:45,873 --> 01:42:49,043 WE NOTED DECREASED SEGREGATION 2793 01:42:49,043 --> 01:42:52,579 IN THOSE INFANTS THAT WENT ON TO 2794 01:42:52,579 --> 01:42:53,447 DEVELOP EARLY CEREBRAL PALSY. 2795 01:42:53,447 --> 01:42:54,948 AND THE SEGREGATION WAS 2796 01:42:54,948 --> 01:42:58,185 DECREASED IN NUMEROUS CENTURY 2797 01:42:58,185 --> 01:43:00,087 MOTOR NODES THAT ARE SHOWN HERE 2798 01:43:00,087 --> 01:43:02,322 ALONG WITH ALSO NODES THAT SUB 2799 01:43:02,322 --> 01:43:05,392 SERVE CON NA TIVE FUNCTION WHICH 2800 01:43:05,392 --> 01:43:06,326 SHOULDN'T SURPRISE US BECAUSE WE 2801 01:43:06,326 --> 01:43:07,961 KNOW HALF OF THESE INFANTS WITH 2802 01:43:07,961 --> 01:43:09,763 CEREBRAL PALSY GO ON TO DEVELOP 2803 01:43:09,763 --> 01:43:15,135 COGNITIVE IMPAIRMENTS. 2804 01:43:15,135 --> 01:43:16,537 INTERESTINGLY, THERE ARE A FEW 2805 01:43:16,537 --> 01:43:18,038 STUDIES THAT CORRELATED 2806 01:43:18,038 --> 01:43:20,074 DIFFUSION MRI WITH PRE TERM 2807 01:43:20,074 --> 01:43:21,375 INFANTS BUT IT'S THE FEW STUDIES 2808 01:43:21,375 --> 01:43:23,010 THAT ARE OUT THERE ARE VERY 2809 01:43:23,010 --> 01:43:24,912 PROMISING AND MOST OF THEM ARE 2810 01:43:24,912 --> 01:43:26,280 ASSOCIATION STUDIES. 2811 01:43:26,280 --> 01:43:29,016 THE FEW THAT ARE PREDICTIVE, 2812 01:43:29,016 --> 01:43:31,351 SUGGEST A POSITIVE LIKELIHOOD 2813 01:43:31,351 --> 01:43:41,729 RATIO BETWEEN 2.8 AND 2814 01:43:45,833 --> 01:43:48,235 AND YOU CAN SEE THAT SOME OF THE 2815 01:43:48,235 --> 01:43:49,403 SAME TRACKS THAT ARE SHOWED IN 2816 01:43:49,403 --> 01:43:52,473 THE PRIOR IMAGE, SUCH AS THE 2817 01:43:52,473 --> 01:43:55,943 FINSPINAL TRACK AND THE RADIATIS 2818 01:43:55,943 --> 01:44:03,884 AND THE CORP IS ASSOCIATED WITH 2819 01:44:03,884 --> 01:44:05,886 A MOTOR SCORES. 2820 01:44:05,886 --> 01:44:07,588 SO, WHILE THESE STUDIES ARE 2821 01:44:07,588 --> 01:44:09,123 PROMISING, THERE ARE ALL SMALL 2822 01:44:09,123 --> 01:44:13,393 AND NONE OF THEM DID ANY KIND OF 2823 01:44:13,393 --> 01:44:14,995 INTERNAL OR EXTERNAL VALIDATION 2824 01:44:14,995 --> 01:44:16,330 BECAUSE IT'S DIFFICULT TO DO 2825 01:44:16,330 --> 01:44:18,465 INTERNAL VALIDATION WITH SMALLER 2826 01:44:18,465 --> 01:44:18,866 STUDIES. 2827 01:44:18,866 --> 01:44:21,301 THAT IS SOMETHING THAT NEEDS TO 2828 01:44:21,301 --> 01:44:23,904 BE DONE. 2829 01:44:23,904 --> 01:44:25,339 SO, WITH THIS SYNAPSE COHORT 2830 01:44:25,339 --> 01:44:27,908 WE'RE IN A GOOD POSITION TO DO 2831 01:44:27,908 --> 01:44:29,009 JUST THAT. 2832 01:44:29,009 --> 01:44:30,644 FIRST, WE DECIDED TO LOOK AT 2833 01:44:30,644 --> 01:44:32,913 STRUCTURE CONNECTIVITY 2834 01:44:32,913 --> 01:44:34,848 BIOMARKERS IN INFANTS WHERE WE 2835 01:44:34,848 --> 01:44:38,218 WERE ABLE TO SUCCESSFULLY GET 2836 01:44:38,218 --> 01:44:41,622 STRUCTURAL CONNECTOME AND HAVE 2837 01:44:41,622 --> 01:44:44,691 OUTCOME DATA FOR CEREBRAL PALSY. 2838 01:44:44,691 --> 01:44:47,161 14% OF OUR COHORT DEVELOPED CP 2839 01:44:47,161 --> 01:44:53,267 AND THIS INCLUDES GMF MILD CP 2840 01:44:53,267 --> 01:44:55,536 AND WE USED ELASTIC NET TO 2841 01:44:55,536 --> 01:44:57,404 IDENTIFY THE TOP BIOMARKERS. 2842 01:44:57,404 --> 01:44:59,540 AND AGAIN, HERE WE USED GRAPH 2843 01:44:59,540 --> 01:45:01,275 THEORY BIOMARKERS AND HERE, YOU 2844 01:45:01,275 --> 01:45:04,444 CAN SEE, THE SIX BIOMARKERS 2845 01:45:04,444 --> 01:45:11,285 INCLUDING THE STRENGTHS OF THE 2846 01:45:11,285 --> 01:45:13,954 SAGITTAL STRATUM AND PONTINE 2847 01:45:13,954 --> 01:45:15,422 CROSSING TRACT AND THEY ARE ALL 2848 01:45:15,422 --> 01:45:16,824 HEAVILY INVOLVED IN MOTOR 2849 01:45:16,824 --> 01:45:19,660 FUNCTION AND WE ALSO SAW THAT 2850 01:45:19,660 --> 01:45:21,929 LOCALLY EFFICIENCY OF THE 2851 01:45:21,929 --> 01:45:24,298 POSTERIOR CORONA RADIATA AND 2852 01:45:24,298 --> 01:45:27,968 CLUSTERING CO EFFICIENT OF 2853 01:45:27,968 --> 01:45:29,369 SAGITTAL EXTRA STRATUM WERE CP 2854 01:45:29,369 --> 01:45:31,772 AND COMBINED THEM THE AREA UNDER 2855 01:45:31,772 --> 01:45:34,508 THE CURVE WAS 0.80 AND YOU CAN 2856 01:45:34,508 --> 01:45:37,444 SEE THAT HERE IN THE AUC CURVE 2857 01:45:37,444 --> 01:45:39,213 ON THE UPPER RIGHT -HAND CORNER. 2858 01:45:39,213 --> 01:45:42,382 THIS IS A RESPECTABLE NUMBER AND 2859 01:45:42,382 --> 01:45:43,784 ESPECIALLY WHEN YOU CONSIDER 2860 01:45:43,784 --> 01:45:45,719 THAT THE BEST CLINICAL MODEL, 2861 01:45:45,719 --> 01:45:47,454 THAT INCLUDES CLINICAL 2862 01:45:47,454 --> 01:45:50,791 PREDICTERS SUCH AS DPD AND IVH, 2863 01:45:50,791 --> 01:45:52,893 IN ADDITION TO STRUCTURAL MRI, 2864 01:45:52,893 --> 01:45:56,763 THE BEST THAT WE CAN DO WAS AN 2865 01:45:56,763 --> 01:45:59,066 AUC AT .65. 2866 01:45:59,066 --> 01:46:01,201 AUC AT .8 IS INSUFFICIENT TO 2867 01:46:01,201 --> 01:46:03,003 MAKE INDIVIDUAL LEVEL 2868 01:46:03,003 --> 01:46:03,303 PREDICTIONS. 2869 01:46:03,303 --> 01:46:05,472 WHEN WE COMBINE THE STRUCTURAL 2870 01:46:05,472 --> 01:46:06,673 CONNECTIVITY BIOMARKERS WITH 2871 01:46:06,673 --> 01:46:08,609 EXISTING BIOMARKERS, WE STILL 2872 01:46:08,609 --> 01:46:11,645 DON'T GET MUCH BETTER THE AUC 2873 01:46:11,645 --> 01:46:14,047 WAS .81. 2874 01:46:14,047 --> 01:46:17,251 SO, WHAT IS IS IT THAT IS 2875 01:46:17,251 --> 01:46:18,285 PROHIBITING US FROM GETTING 2876 01:46:18,285 --> 01:46:18,785 THERE? 2877 01:46:18,785 --> 01:46:21,021 ESPECIALLY WHEN OTHER STUDIES 2878 01:46:21,021 --> 01:46:23,557 HAVE REPORTED AUCs AS HIGH AS 2879 01:46:23,557 --> 01:46:24,124 .9? 2880 01:46:24,124 --> 01:46:26,393 WELL, ONE THING IS THAT THOSE 2881 01:46:26,393 --> 01:46:28,128 STUDIES SUCH AS THE ONE FROM THE 2882 01:46:28,128 --> 01:46:29,930 NETWORK, INCLUDED DEATH AS ONE 2883 01:46:29,930 --> 01:46:31,365 OF THE OUTCOME MEASURES. 2884 01:46:31,365 --> 01:46:33,300 IT WAS CP OR DEATH AND THE OTHER 2885 01:46:33,300 --> 01:46:36,336 THING IS THEY USE MONITOR TO 2886 01:46:36,336 --> 01:46:38,572 SEVERE CP RATHER THAN INCLUDING 2887 01:46:38,572 --> 01:46:39,406 MILD CP. 2888 01:46:39,406 --> 01:46:41,174 I'LL GET INTO THAT IN A LITTLE 2889 01:46:41,174 --> 01:46:41,341 BIT. 2890 01:46:41,341 --> 01:46:42,943 HERE IS MORE DATA FROM OUR 2891 01:46:42,943 --> 01:46:44,945 SYNAPSE COHORT AS I MENTIONED, 2892 01:46:44,945 --> 01:46:46,747 14% OR 48 INFANTS IN TOTAL 2893 01:46:46,747 --> 01:46:49,917 DEVELOPED CP INCLUDING MILD CP 2894 01:46:49,917 --> 01:46:51,351 AT TWO YEARS CORRECTED AGE. 2895 01:46:51,351 --> 01:46:53,954 AND HERE ARE THE PROGNOSTIC 2896 01:46:53,954 --> 01:46:55,756 VALUES FOR THE DIFFERENT 2897 01:46:55,756 --> 01:46:57,891 MEASURES THAT WE'VE EXAMINED SO 2898 01:46:57,891 --> 01:46:58,058 FAR. 2899 01:46:58,058 --> 01:46:59,660 SO SEVERE INJURIES ON STRUCTURAL 2900 01:46:59,660 --> 01:47:03,230 MRI HAD A 29% SENSITIVITY AND A 2901 01:47:03,230 --> 01:47:04,765 90% SPECIFICITY SO THE 2902 01:47:04,765 --> 01:47:06,400 SENSITIVITY AGAIN IS QUITE LOW, 2903 01:47:06,400 --> 01:47:09,536 ESPECIALLY SINCE WE'VE INCLUDED 2904 01:47:09,536 --> 01:47:11,171 LEVEL 1 GROSS MOTOR FUNCTION 2905 01:47:11,171 --> 01:47:16,743 CLASSIFICATION AND CP AND THE 2906 01:47:16,743 --> 01:47:18,045 KEY THINGS AND QUITE LET FOR 2907 01:47:18,045 --> 01:47:23,850 MOST OF THESE TESTS AND GENERAL 2908 01:47:23,850 --> 01:47:24,551 MOVEMENT AND NEUROLOGICAL AND 2909 01:47:24,551 --> 01:47:26,219 EVEN WHEN YOU COMBINE IT WITH 2910 01:47:26,219 --> 01:47:30,390 STRUCTURAL MRI AND HAS BEEN 2911 01:47:30,390 --> 01:47:32,059 RECOMMENDED AND AND GUIDELINE 2912 01:47:32,059 --> 01:47:34,394 AND WE DON'T DO VERY WELL AS FAR 2913 01:47:34,394 --> 01:47:35,862 AS SENSITIVITY IS CONCERNED SO 2914 01:47:35,862 --> 01:47:39,066 IT'S DIFFICULT TO RULE OUT CP 2915 01:47:39,066 --> 01:47:42,469 AND THE SPECIFICITY IS HIGH AND 2916 01:47:42,469 --> 01:47:47,808 THE AUC AGAIN IS NOT IDEAL TO 2917 01:47:47,808 --> 01:47:50,577 WON'T RULE IN AND RULE OUT 2918 01:47:50,577 --> 01:47:51,211 CEREBRAL PALSY. 2919 01:47:51,211 --> 01:47:53,213 WHEN WE COMBINE GMA WITH 2920 01:47:53,213 --> 01:47:56,149 STRUCTURAL CONNECTIVITY AND MRI, 2921 01:47:56,149 --> 01:47:58,285 OUR AUC DOES NOT IMPROVE. 2922 01:47:58,285 --> 01:48:00,320 MUCH ABOVE THE .81 THAT I JUST 2923 01:48:00,320 --> 01:48:01,054 SHOWED UP. 2924 01:48:01,054 --> 01:48:03,724 SO, AGAIN, I THINK THAT THIS HAS 2925 01:48:03,724 --> 01:48:05,726 TO DO WITH THE FACT THAT WE'RE 2926 01:48:05,726 --> 01:48:07,995 INCLUDING THIS MILDER FORM OF CP 2927 01:48:07,995 --> 01:48:09,429 WHICH MANY PARENTS WOULD ARGUE 2928 01:48:09,429 --> 01:48:12,399 IS STILL IMPORTANT THAT WE FIND 2929 01:48:12,399 --> 01:48:14,768 A WAY TO DIAGNOSE THESE KIDS 2930 01:48:14,768 --> 01:48:17,704 EARLIER THAN TWO YEARS OF AGE. 2931 01:48:17,704 --> 01:48:19,740 SO, WHEN WE RESTRICT OUR 2932 01:48:19,740 --> 01:48:22,209 PREDICTION TO MODERATE TO SEVERE 2933 01:48:22,209 --> 01:48:26,380 CP OR THE GMSCS IS 2 OR HIGHER, 2934 01:48:26,380 --> 01:48:28,849 FIRST WE'RE LIMITED IN OUR 2935 01:48:28,849 --> 01:48:30,884 COHORT BECAUSE ONLY 3.6% 2936 01:48:30,884 --> 01:48:32,519 DEVELOPS CP. 2937 01:48:32,519 --> 01:48:33,020 THANKFULLY. 2938 01:48:33,020 --> 01:48:38,425 BUT IT DOES MAKE PROGNOSTICATION 2939 01:48:38,425 --> 01:48:38,692 DIFFICULT. 2940 01:48:38,692 --> 01:48:42,896 IN OUR CASE, THE AT LEAST FOR 2941 01:48:42,896 --> 01:48:44,798 STRUCTURAL MRI AND GMA, THOSE 2942 01:48:44,798 --> 01:48:49,436 ARE ONLY TWO PREDICTORS SO THAT 2943 01:48:49,436 --> 01:48:51,571 IS -- WE HAVE THE POWER TO DO 2944 01:48:51,571 --> 01:48:53,607 FIVE PREDICTORS WITH THIS 2945 01:48:53,607 --> 01:48:55,142 OUTCOME MEASURE AND THAT'S WHAT 2946 01:48:55,142 --> 01:48:57,010 WE DID AND SURE ENOUGH, THE 2947 01:48:57,010 --> 01:48:59,379 SENSITIVITY IMPROVES 2948 01:48:59,379 --> 01:49:01,782 SIGNIFICANTLY UP TO 83% WITH 2949 01:49:01,782 --> 01:49:03,683 STRUCTURAL MRI AND WHEN YOU 2950 01:49:03,683 --> 01:49:05,085 COMBINE IT THE SENSITIVITY GOES 2951 01:49:05,085 --> 01:49:07,187 DOWN BUT THE SPECIFICITY GOES UP 2952 01:49:07,187 --> 01:49:09,923 AND THE POSITIVE LIKELIHOOD 2953 01:49:09,923 --> 01:49:11,358 RATIO IS 187. 2954 01:49:11,358 --> 01:49:13,760 YOU NEED AT LEAST ABOUT 30 TO 35 2955 01:49:13,760 --> 01:49:15,529 TO MAKE INDIVIDUAL LEVEL 2956 01:49:15,529 --> 01:49:16,730 PROGRESS NOSTACATESES SO IT 2957 01:49:16,730 --> 01:49:23,870 PROGNOSTICATION SO TO CRUEL OUT 2958 01:49:23,870 --> 01:49:25,839 CP, YOU ARE GOING TO MISS ABOUT 2959 01:49:25,839 --> 01:49:29,409 18 TO 20% OF THE CASES AND WITH 2960 01:49:29,409 --> 01:49:31,645 CP OR UP TO 40 IF YOU ARE USING 2961 01:49:31,645 --> 01:49:35,182 STRUCTURAL MRI AND GMA SAYS 2962 01:49:35,182 --> 01:49:37,084 BECOMING THE STANDARD IN MANY 2963 01:49:37,084 --> 01:49:39,352 INSTITUTIONS INCLUDING OURS. 2964 01:49:39,352 --> 01:49:41,621 WHEN WE LOOK AT STRUCTURAL 2965 01:49:41,621 --> 01:49:43,590 CONNECTIVITY WE SEE AN AUC MUCH 2966 01:49:43,590 --> 01:49:47,360 THE SAME AS GMA AND STRUCTURAL 2967 01:49:47,360 --> 01:49:47,627 MRI. 2968 01:49:47,627 --> 01:49:50,163 AND KEEP IN MIND THIS IS THAT 2969 01:49:50,163 --> 01:49:50,764 DETERMINE CORRECTED AGE WHERE 2970 01:49:50,764 --> 01:49:52,933 THE GMA AND YOU HAVE TO WAIT 2971 01:49:52,933 --> 01:49:55,635 UNTIL THREE TO FOUR MONTHS TO 2972 01:49:55,635 --> 01:49:57,170 OBTAIN THOSE TESTS IN YOU WANTED 2973 01:49:57,170 --> 01:49:59,573 TO BE ACCURATE. 2974 01:49:59,573 --> 01:50:01,341 SO, WHEN YOU ADD GMA TO 2975 01:50:01,341 --> 01:50:02,876 STRUCTURAL CONNECTIVITY AND 2976 01:50:02,876 --> 01:50:06,446 STRUCTURAL MRI THE AUC REMAINS 2977 01:50:06,446 --> 01:50:06,847 HIGH. 2978 01:50:06,847 --> 01:50:08,582 THERE'S PROMISE HERE FOR 2979 01:50:08,582 --> 01:50:10,217 MODERATE TO SEVERE CP 2980 01:50:10,217 --> 01:50:11,918 PREDICTION, HOWEVER, MORE NEEDS 2981 01:50:11,918 --> 01:50:15,055 TO BE DONE FOR MILDER CP. 2982 01:50:15,055 --> 01:50:18,024 SO WHAT CAN WE CONCLUDE FROM 2983 01:50:18,024 --> 01:50:19,926 ADVANCES IN RESEARCH IN THIS 2984 01:50:19,926 --> 01:50:20,427 AREA? 2985 01:50:20,427 --> 01:50:22,062 WELL, ONE, I THINK WE CAN SAY 2986 01:50:22,062 --> 01:50:23,029 THAT BETTER KNOWLEDGE AND 2987 01:50:23,029 --> 01:50:24,164 OBJECTIVE ASSESSMENT OF 2988 01:50:24,164 --> 01:50:27,234 STRUCTURAL MRI INJURY, HAVE 2989 01:50:27,234 --> 01:50:27,701 CONTRIBUTED TIME PROVE 2990 01:50:27,701 --> 01:50:30,237 SENSITIVITY IN PREDICTING 2991 01:50:30,237 --> 01:50:31,104 CEREBRAL PALSY. 2992 01:50:31,104 --> 01:50:33,740 STRUCTURAL MRI PLUS GMA APPEARS 2993 01:50:33,740 --> 01:50:35,041 SUFFICIENTLY ACCURATE TO PRO 2994 01:50:35,041 --> 01:50:37,244 DICTIONARY MODERATE TO SEVERE 2995 01:50:37,244 --> 01:50:37,410 CP. 2996 01:50:37,410 --> 01:50:39,146 AT LEAST LEVEL 2 OR HIGHER. 2997 01:50:39,146 --> 01:50:40,547 HOWEVER, SENSITIVITY OF 2998 01:50:40,547 --> 01:50:44,050 STRUCTURAL MRI PLUS GMA OR HINE 2999 01:50:44,050 --> 01:50:45,652 ARE TOO LOW AND THIS COMBINATION 3000 01:50:45,652 --> 01:50:47,320 IS UNABLE TO RULE OUT ALL LEVELS 3001 01:50:47,320 --> 01:50:50,023 OF CP. 3002 01:50:50,023 --> 01:50:51,224 INCLUSIVE OF MILD CP. 3003 01:50:51,224 --> 01:50:53,326 WE NEED MORE SENSITIVE AND 3004 01:50:53,326 --> 01:50:59,633 OBJECTIVE TESTS TO RULE OUT MILD 3005 01:50:59,633 --> 01:51:00,033 CP. 3006 01:51:00,033 --> 01:51:02,335 AND GRAPH METRICS AND STRUCTURAL 3007 01:51:02,335 --> 01:51:03,537 CONNECTIVITY MAY BE POISE TO 3008 01:51:03,537 --> 01:51:06,273 FILL THIS KNOWLEDGE GAP AND 3009 01:51:06,273 --> 01:51:08,074 IMPROVE PREDICTION OF MILD CP AS 3010 01:51:08,074 --> 01:51:08,308 WELL. 3011 01:51:08,308 --> 01:51:10,076 OUR COHORT, WE'VE COLLECTED 3012 01:51:10,076 --> 01:51:11,344 RESTING STATE FUNCTIONAL 3013 01:51:11,344 --> 01:51:14,014 CONNECTIVITY DATA AND MR DATA AS 3014 01:51:14,014 --> 01:51:15,248 WELL AND WE BELIEVE THIS WILL 3015 01:51:15,248 --> 01:51:17,150 FURTHER ENHANCE SENSITIVITY 3016 01:51:17,150 --> 01:51:19,252 ESPECIALLY IN THE MILDER FORMS 3017 01:51:19,252 --> 01:51:23,089 OF CP AND GENETIC, EPI GENETIC 3018 01:51:23,089 --> 01:51:25,959 T. AND BIOMARKERS ALSO OFFER 3019 01:51:25,959 --> 01:51:27,527 ADDITIONAL MEANS TO ENHANCE 3020 01:51:27,527 --> 01:51:28,728 PREDICTION OF CP AND WE HAVE 3021 01:51:28,728 --> 01:51:31,665 SOME OF THIS DATA AS WELL AND 3022 01:51:31,665 --> 01:51:33,400 OTHERS, OTHER GROUPS ARE LOOKING 3023 01:51:33,400 --> 01:51:36,603 AT THIS SO IT WILL BE GREAT TO 3024 01:51:36,603 --> 01:51:39,172 SEE THESE STUDIES AS WELL AS A 3025 01:51:39,172 --> 01:51:40,740 COMBINATION OF THESE BIOMARKERS 3026 01:51:40,740 --> 01:51:43,443 BOTH IMAGING AND BLOOD 3027 01:51:43,443 --> 01:51:46,379 BIOMARKERS TO IMPROVE OUR 3028 01:51:46,379 --> 01:51:49,416 ABILITY TO SENSITIVITY DETECT CP 3029 01:51:49,416 --> 01:51:53,954 AND RULE IT OUT WHEN IT'S NOT 3030 01:51:53,954 --> 01:51:54,221 NEGATIVE. 3031 01:51:54,221 --> 01:51:56,356 WE ARE ALSO USING, WE AND OTHERS 3032 01:51:56,356 --> 01:51:58,425 ARE USING MACHINE AND DEEP 3033 01:51:58,425 --> 01:51:59,993 LEARNING APPROACHES TO 3034 01:51:59,993 --> 01:52:05,465 INDIVIDUAL EYES PREDIIZE THEPREE 3035 01:52:05,465 --> 01:52:06,866 WITH ALL OF THESE STUDIES THAT 3036 01:52:06,866 --> 01:52:08,535 ARE HOPEFULLY GOING TO FIND MORE 3037 01:52:08,535 --> 01:52:11,004 AND MORE BIOMARKERS WE WILL NEED 3038 01:52:11,004 --> 01:52:14,808 A LARGE NIH STUDY THAT WILL 3039 01:52:14,808 --> 01:52:17,544 OFFER EXTERNAL VALIDATION WHICH 3040 01:52:17,544 --> 01:52:19,079 IS CRITICAL BEFORE IT CAN BE 3041 01:52:19,079 --> 01:52:21,081 TRANSLATED TO THE BEDSIDE. 3042 01:52:21,081 --> 01:52:27,954 THANK YOU SO MUCH FOR YOUR 3043 01:52:27,954 --> 01:52:32,525 ATTENTION. 3044 01:52:32,525 --> 01:52:37,931 SO THANK YOU TO VERY MUCH TO 3045 01:52:37,931 --> 01:52:42,836 DrTHE DOCTORS. 3046 01:52:42,836 --> 01:52:45,071 WE'LL TAKE A SHORT BREAK AND 3047 01:52:45,071 --> 01:52:46,606 RECONVENE AT 1:15:00 P.M. 3048 01:52:46,606 --> 01:52:48,208 EASTERN TIME SO IN ABOUT 30 3049 01:52:48,208 --> 01:52:50,306 MINUTES. THANK YOU. 3050 01:52:50,306 --> 01:52:52,708 OUR NEXT SET OF PRESENTATIONS 3051 01:52:52,708 --> 01:52:55,010 WILL BEGIN WITH Dr. QUINLAN 3052 01:52:55,010 --> 01:52:57,880 WHO IS AN ASSISTANT PROFESSOR IN 3053 01:52:57,880 --> 01:53:02,184 THE GEORGE AND ANNE RYAN CENTER 3054 01:53:02,184 --> 01:53:03,119 FOR NEUROSCIENCE AT THE 3055 01:53:03,119 --> 01:53:04,820 UNIVERSITY OF RHODE ISLAND. 3056 01:53:04,820 --> 01:53:06,355 SHE WILL SPEAK ABOUT DEVELOPING 3057 01:53:06,355 --> 01:53:07,623 NEW BIOMARKERS AND 3058 01:53:07,623 --> 01:53:11,427 PHARMACEUTICAL TREATMENTS FOR 3059 01:53:11,427 --> 01:53:11,794 CEREBRAL PALSY. 3060 01:53:11,794 --> 01:53:14,897 FOLLOWING Dr. QUINLAN, WILL BE 3061 01:53:14,897 --> 01:53:19,435 A PRESENTATION FROM Dr. 3062 01:53:19,435 --> 01:53:24,073 NATALIE MAITRE NEURO DEVELOPMENT 3063 01:53:24,073 --> 01:53:26,208 AT HIGH-RISK NEW BORNS AND 3064 01:53:26,208 --> 01:53:28,711 REHABILITATION AT LONG-TERM DIS 3065 01:53:28,711 --> 01:53:31,547 BILL TEES. 3066 01:53:31,547 --> 01:53:34,984 NOW OWE DEVELOPMENT OF HIGH-RISK 3067 01:53:34,984 --> 01:53:36,285 NEWBORNS AND REHABILITATION OF 3068 01:53:36,285 --> 01:53:37,953 LONG-TERM DISABILITIES AT CP AND 3069 01:53:37,953 --> 01:53:40,556 OUR FINAL SPEAKER TODAY WILL BE 3070 01:53:40,556 --> 01:53:50,699 Dr. BURNADE BERNADETTE GILLICK M 3071 01:53:50,699 --> 01:53:58,374 THE UNIVERSITY WHICH.CORTICAL PY 3072 01:53:58,374 --> 01:53:59,942 FROM NEUROLOGICAL INSULT IN BOTH 3073 01:53:59,942 --> 01:54:02,444 ADULT AND PEDIATRIC POPULATIONS. 3074 01:54:02,444 --> 01:54:05,748 SO LET'S GO AHEAD AND GET THIS 3075 01:54:05,748 --> 01:54:12,755 NEXT SET OF PRESENTATIONS 3076 01:54:12,755 --> 01:54:13,656 STARTED. 3077 01:54:13,656 --> 01:54:18,427 >> HI, I'M AN ASSISTANT 3078 01:54:18,427 --> 01:54:20,229 PROFESSOR AT THE COLLEGE OF 3079 01:54:20,229 --> 01:54:21,730 PHARMACY AT THE UNIVERSITY OF 3080 01:54:21,730 --> 01:54:24,834 ROAD I'D LINE. 3081 01:54:24,834 --> 01:54:28,103 SIXTH I HAVE A BACKGROUND IN 3082 01:54:28,103 --> 01:54:29,505 SPINAL CORD PHYSIOLOGY. 3083 01:54:29,505 --> 01:54:31,974 SO I BRING THIS SKILLS SET TO 3084 01:54:31,974 --> 01:54:34,543 DEVELOPING NEW BIOMARKERS AND 3085 01:54:34,543 --> 01:54:36,011 PHARMACEUTICAL TREATMENTS FOR 3086 01:54:36,011 --> 01:54:37,012 CEREBRAL PALSY. 3087 01:54:37,012 --> 01:54:40,082 SO BIOMARKERS AS WE ALL KNOW, CP 3088 01:54:40,082 --> 01:54:41,483 IS NOT DIAGNOSED UNTIL ONE OR 3089 01:54:41,483 --> 01:54:43,485 TWO YEARS OF AGE, EVEN THOUGH 3090 01:54:43,485 --> 01:54:46,222 THERE ARE METHODS OF EARLY 3091 01:54:46,222 --> 01:54:46,522 PREDICTION. 3092 01:54:46,522 --> 01:54:49,658 AT AGE OF LESS THAN SIX MONTHS 3093 01:54:49,658 --> 01:54:50,125 IN KIDS. 3094 01:54:50,125 --> 01:54:51,660 SOME OF THE BEST METHODS FOR 3095 01:54:51,660 --> 01:54:56,265 EARLY DETECTION, ARE QUALITATIVE 3096 01:54:56,265 --> 01:54:57,233 ASSESSMENTS AND GENERAL 3097 01:54:57,233 --> 01:55:01,237 MOVEMENTS ASSESSMENT. 3098 01:55:01,237 --> 01:55:02,438 NEUROLOGICAL INFANT EXAM ALONG 3099 01:55:02,438 --> 01:55:03,372 WITH MRI. 3100 01:55:03,372 --> 01:55:05,507 WHAT IMPRESSESES ME MOST ABOUT 3101 01:55:05,507 --> 01:55:08,344 THIS LIST OF GOOD EARLY 3102 01:55:08,344 --> 01:55:10,946 PREDICTORS, IS THAT TWO OF THEM, 3103 01:55:10,946 --> 01:55:12,381 THE GENERAL MOVEMENT ASSESSMENT 3104 01:55:12,381 --> 01:55:16,352 AND THE NEUROLOGICAL EXAM ARE 3105 01:55:16,352 --> 01:55:18,254 BASED ON SPONTANEOUS MOVEMENTS 3106 01:55:18,254 --> 01:55:20,489 IN INFANTS AND REFLEX CIRCUITS 3107 01:55:20,489 --> 01:55:21,924 WHICH ARE PRESENT IN INFANTS. 3108 01:55:21,924 --> 01:55:25,160 SO THEY'RE REALLY MOVEMENT BASED 3109 01:55:25,160 --> 01:55:25,494 EXAMS. 3110 01:55:25,494 --> 01:55:27,396 AND THESE EXAMS WITH A TRAINED 3111 01:55:27,396 --> 01:55:32,234 AND QUALIFIED OBSERVER, 3112 01:55:32,234 --> 01:55:33,969 POTENTIALLY COULD BE EVEN MORE 3113 01:55:33,969 --> 01:55:36,171 ACCURATE THAN AN INACCESSIBLE 3114 01:55:36,171 --> 01:55:42,211 MRI, AT LEAST BASED ON THE DATA 3115 01:55:42,211 --> 01:55:43,746 PRESENT INSIDE THIS ARTICLE WHAT 3116 01:55:43,746 --> 01:55:46,582 IS IT THAT THE GENERAL MOVEMENTS 3117 01:55:46,582 --> 01:55:48,017 EXAM LOOKS AT AND WE'RE GOING TO 3118 01:55:48,017 --> 01:55:49,318 FOCUS IN ON THE GENERAL 3119 01:55:49,318 --> 01:55:50,819 MOVEMENTS ASSESSMENT. 3120 01:55:50,819 --> 01:55:52,755 IT LOOKS AT SPONTANEOUS MOVEMENT 3121 01:55:52,755 --> 01:55:56,425 IN INFANTS AND HERE IS MY 3122 01:55:56,425 --> 01:55:58,427 3-MONTH-OLD DAUGHTER MAKING SOME 3123 01:55:58,427 --> 01:56:00,696 VERY TYPICAL MOVEMENTS FOR AN 3124 01:56:00,696 --> 01:56:04,566 INFANT THAT AGE. 3125 01:56:04,566 --> 01:56:07,136 SO, WHAT IS SPONTANEOUS 3126 01:56:07,136 --> 01:56:07,603 MOVEMENTS. 3127 01:56:07,603 --> 01:56:09,171 NEWBORNS AND PRE TERM INFANTS 3128 01:56:09,171 --> 01:56:12,574 MAKE MOVEMENTS THAT CAN BE 3129 01:56:12,574 --> 01:56:13,742 CLASSIFIED AS RISING. 3130 01:56:13,742 --> 01:56:15,678 THEY'RE NOT KNOWN FOR 3131 01:56:15,678 --> 01:56:17,246 COORDINATED MOTOR ACTIVITIES OR 3132 01:56:17,246 --> 01:56:18,547 LOCOMOTION AND IT'S NOT UNTIL 3133 01:56:18,547 --> 01:56:19,848 SEVERAL MONTHS OF AGE, AROUND 3134 01:56:19,848 --> 01:56:21,150 SIX OR SEVEN MONTHS OF AGE THAT 3135 01:56:21,150 --> 01:56:22,918 THEY CAN MAKE INTENTIONAL 3136 01:56:22,918 --> 01:56:25,154 MOVEMENTS, THEY CAN PICK UP THAT 3137 01:56:25,154 --> 01:56:27,389 CHERRIO OR MAKE ANTI GRAVITY 3138 01:56:27,389 --> 01:56:30,326 MOVEMENTS SORRY WEIGHTS OR 3139 01:56:30,326 --> 01:56:31,894 CRAWL. 3140 01:56:31,894 --> 01:56:35,397 BRIDGES THESE TWO PATTERNS OF 3141 01:56:35,397 --> 01:56:40,369 MOVEMENT, IS A PERIOD KNOWN AS 3142 01:56:40,369 --> 01:56:43,572 THE FIDGETY MOVEMENT AND IT 3143 01:56:43,572 --> 01:56:45,808 SIGNALS THE TRANSITION FROM 3144 01:56:45,808 --> 01:56:49,678 SPINAL-DRIVEN LOCOMOTIVE 3145 01:56:49,678 --> 01:56:52,381 ACTIVITY TO CORTICAL 3146 01:56:52,381 --> 01:56:53,482 SPINAL-DRIVEN VOLUNTARY 3147 01:56:53,482 --> 01:56:55,417 INTENTIONAL MOVEMENTS. 3148 01:56:55,417 --> 01:56:58,988 SO, IN TYPICAL DEVELOPING KIDS, 3149 01:56:58,988 --> 01:57:00,989 THE FIDGET TEE MOVEMENTS IS 3150 01:57:00,989 --> 01:57:03,726 INCREDIBLY INDICATIVE OF THE 3151 01:57:03,726 --> 01:57:05,294 CORTICAL SPINAL TRACT TAKING 3152 01:57:05,294 --> 01:57:05,694 CONTROL. 3153 01:57:05,694 --> 01:57:07,529 IN KIDS WITH CEREBRAL PALSY, 3154 01:57:07,529 --> 01:57:09,798 MOVEMENTS INSTEAD OF BEING 3155 01:57:09,798 --> 01:57:11,700 FIDGETY, ARE CRAMPED AND 3156 01:57:11,700 --> 01:57:12,167 SYNCHRONIZED. 3157 01:57:12,167 --> 01:57:15,170 SO, LET'S TAKE A LOOK AT WHAT 3158 01:57:15,170 --> 01:57:16,138 PRODUCES THESE DIFFERENT 3159 01:57:16,138 --> 01:57:19,141 PATTERNS OF MOVEMENT FROM THE 3160 01:57:19,141 --> 01:57:22,111 PERSPECTIVE OF COURSE OF THE 3161 01:57:22,111 --> 01:57:22,745 SPINAL CORD PHYSICALLOLOGIST, 3162 01:57:22,745 --> 01:57:23,278 ME. 3163 01:57:23,278 --> 01:57:24,580 LOOKING AT WEEKS POST 3164 01:57:24,580 --> 01:57:25,781 CONSUMPTION IN HUMANS AND 3165 01:57:25,781 --> 01:57:29,051 FOCUSING ON THE TIME THAT 3166 01:57:29,051 --> 01:57:34,256 PRODUCES THE SPONTANEOUS RITHING 3167 01:57:34,256 --> 01:57:36,058 MOVEMENT AND THE START OF THE 3168 01:57:36,058 --> 01:57:37,226 SPONTANEOUS MOVEMENT AND ENDING 3169 01:57:37,226 --> 01:57:40,896 WITH THE TRANSITION O CORTICAL 3170 01:57:40,896 --> 01:57:42,831 CONTROL AND FIDGETY MOVEMENT. 3171 01:57:42,831 --> 01:57:44,466 THE FIRST THING WE NEED FOR 3172 01:57:44,466 --> 01:57:46,201 DEVELOPING NERVOUS SYSTEM TO 3173 01:57:46,201 --> 01:57:47,269 PRODUCE THESE SPONTANEOUS 3174 01:57:47,269 --> 01:57:49,138 MOVEMENT IS INTERVENTION OF THE 3175 01:57:49,138 --> 01:57:49,538 MUSCLE. 3176 01:57:49,538 --> 01:57:51,407 SO DEVELOPING MOTOR NEURONS, 3177 01:57:51,407 --> 01:57:54,009 EXIT THE NEURAL TUBE AND REACH 3178 01:57:54,009 --> 01:57:57,780 OUT INTO THE PERIPHERY AND THE 3179 01:57:57,780 --> 01:57:58,947 DEVELOPING MUSCLE. 3180 01:57:58,947 --> 01:58:00,249 NOW THAT HAPPENS EARLY IN 3181 01:58:00,249 --> 01:58:02,117 DEVELOPMENT BUT OBVIOUSLY, AND 3182 01:58:02,117 --> 01:58:05,954 AROUND THE SAME TIME THIS IS 3183 01:58:05,954 --> 01:58:07,356 HAPPENING, YOU HAVE FIBERS 3184 01:58:07,356 --> 01:58:08,857 WRITHING IN THE SPINAL CORD 3185 01:58:08,857 --> 01:58:12,027 ARRIVING FROM THE DEVELOPING 3186 01:58:12,027 --> 01:58:15,097 NUCLEUS IN THE BRAIN STEM AND 3187 01:58:15,097 --> 01:58:18,367 SEROTONIN IS VERY IMPORTANT IN 3188 01:58:18,367 --> 01:58:21,103 THE DEVELOPMENT FOR THE SPINAL 3189 01:58:21,103 --> 01:58:23,305 CORD SPECIFICALLY IN OTHER 3190 01:58:23,305 --> 01:58:24,740 NEURAL AREAS AS WELL. 3191 01:58:24,740 --> 01:58:29,812 SO SEROTONIN PROMOTES NURITE 3192 01:58:29,812 --> 01:58:30,779 OUTGROWTH AND THE DEVELOPMENT ON 3193 01:58:30,779 --> 01:58:33,382 THE CELLULAR LEVEL AND PROMOTES 3194 01:58:33,382 --> 01:58:34,817 NEURAL DEVELOPMENT AT THE 3195 01:58:34,817 --> 01:58:35,751 CIRCUIT LEVEL. 3196 01:58:35,751 --> 01:58:41,657 SO IT DEPOLARIZES AND 3197 01:58:41,657 --> 01:58:42,958 FACILITATES SPONTANEOUS NEURAL 3198 01:58:42,958 --> 01:58:43,625 ACTIVITY. 3199 01:58:43,625 --> 01:58:44,860 THE SPONTANEOUS NEURAL ACTIVITY 3200 01:58:44,860 --> 01:58:50,399 ISN'T DRIVEN BY SEROTONIN ALONE 3201 01:58:50,399 --> 01:58:54,403 BUT BY GLUTE MATE, GABA AND TO 3202 01:58:54,403 --> 01:58:57,339 SOME DEGREE AND IT'S PROMOTED BY 3203 01:58:57,339 --> 01:58:57,906 SEROTONIN. 3204 01:58:57,906 --> 01:58:59,608 SEROTONIN IS RELEASED BY VOLUME 3205 01:58:59,608 --> 01:59:00,542 TRANSMISSION SO THERE'S A LOT OF 3206 01:59:00,542 --> 01:59:02,544 IT JUST FLOATING AROUND IN THE 3207 01:59:02,544 --> 01:59:04,613 SPINAL FLUID AT THIS 3208 01:59:04,613 --> 01:59:06,248 DEVELOPMENTAL STAGE. 3209 01:59:06,248 --> 01:59:08,517 NEURONS, BY DEVELOPING, EX 3210 01:59:08,517 --> 01:59:11,119 EXPRESS SEROTONIN RECEPTORS 3211 01:59:11,119 --> 01:59:13,088 THROUGHOUT THE SOMA SO THEY'RE 3212 01:59:13,088 --> 01:59:17,392 NOT RESTRICTED TO SYNAPTIC SITES 3213 01:59:17,392 --> 01:59:20,562 BUT SENSITIVE TO SEROTONIN IN 3214 01:59:20,562 --> 01:59:23,165 THE DEVELOPMENTAL TIME PERIOD. 3215 01:59:23,165 --> 01:59:25,601 SO SEROTONIN, AS YOU CAN TELL, 3216 01:59:25,601 --> 01:59:28,704 IS ONE OF MY BIG INTERESTS IN 3217 01:59:28,704 --> 01:59:31,406 THE FORMING AND THE SHAPING OF 3218 01:59:31,406 --> 01:59:32,908 NEURAL ACTIVITY. 3219 01:59:32,908 --> 01:59:34,409 WHAT HAPPENS, OF COURSE, AFTER 3220 01:59:34,409 --> 01:59:36,578 SPONTANEOUS MOVEMENTS BEGIN, 3221 01:59:36,578 --> 01:59:38,647 THIS PROMOTES MORE DEVELOPMENT 3222 01:59:38,647 --> 01:59:45,287 IN THE CIRCUIT FORMATION SO YOU 3223 01:59:45,287 --> 01:59:48,123 HAVE THE MUSCLE THE MOTOR 3224 01:59:48,123 --> 01:59:52,528 NEURONS AND THEY'RE ALSO NEURONS 3225 01:59:52,528 --> 01:59:54,530 IN THE SPINAL CORD THAT 3226 01:59:54,530 --> 01:59:57,799 EVENTUALLY WILL HELP SEGREGATE 3227 01:59:57,799 --> 02:00:00,035 SENSORY ACTIVITY AND LEFT AND 3228 02:00:00,035 --> 02:00:01,436 RIGHT COORDINATION. 3229 02:00:01,436 --> 02:00:03,972 SO FORMATION OF THOSE CIRCUITS 3230 02:00:03,972 --> 02:00:06,542 IS VERY DEPENDENT ON THAT 3231 02:00:06,542 --> 02:00:10,546 SPONTANEOUS ACTIVITY. 3232 02:00:10,546 --> 02:00:13,248 AT 24 WEEKS POST CONCEPTION, 3233 02:00:13,248 --> 02:00:15,717 CORTICAL SPINAL TRACKS REACH 3234 02:00:15,717 --> 02:00:17,052 CERVICAL SPINAL CORD AND THIS IS 3235 02:00:17,052 --> 02:00:20,222 JUST THE ENTRY POINT INTO THE 3236 02:00:20,222 --> 02:00:24,192 MOST AREAS OF THE SPINAL CORD 3237 02:00:24,192 --> 02:00:26,094 AND THE PROGRESSION INTO THE 3238 02:00:26,094 --> 02:00:27,362 LUMBAR CORD AND THE PARTICULAR 3239 02:00:27,362 --> 02:00:29,731 FORMATION OF SYNAPSES, BY 3240 02:00:29,731 --> 02:00:31,667 CORTICAL SPINAL TRACKS, WILL 3241 02:00:31,667 --> 02:00:35,037 PROGRESS FOR THE NEXT FEW YEARS. 3242 02:00:35,037 --> 02:00:37,506 AND OF COURSE, AT THIS POINT, 3243 02:00:37,506 --> 02:00:39,141 POST NATALLY THE CORTICAL SPINAL 3244 02:00:39,141 --> 02:00:41,076 TRACT IS TRYING TO EXERT CONTROL 3245 02:00:41,076 --> 02:00:42,210 OVER THE SPINAL CORD. 3246 02:00:42,210 --> 02:00:43,045 WHAT HAPPENS IN BETWEEN THE 3247 02:00:43,045 --> 02:00:44,346 POINT WHERE THEY A ARRIVE AND 3248 02:00:44,346 --> 02:00:47,382 THE POINT WHERE THEY'RE TAKING 3249 02:00:47,382 --> 02:00:47,716 CONTROL? 3250 02:00:47,716 --> 02:00:50,586 THIS IS AN AREA THAT INTERESTS 3251 02:00:50,586 --> 02:00:52,955 ME VERY MUCH IN COMPARING THE 3252 02:00:52,955 --> 02:00:54,356 TYPICALLY DEVELOPING NERVOUS 3253 02:00:54,356 --> 02:00:58,126 SYSTEM WITH A NERVOUS SYSTEM 3254 02:00:58,126 --> 02:00:59,895 THAT HAS HAD AN INSULT OR AN 3255 02:00:59,895 --> 02:01:03,966 INJURY THAT WILL CAUSE CEREBRAL 3256 02:01:03,966 --> 02:01:04,333 PALSY. 3257 02:01:04,333 --> 02:01:05,500 ONE OF THE THINGS THAT HAPPENS 3258 02:01:05,500 --> 02:01:12,841 DURING THIS TIME IS AVENUER ANTS 3259 02:01:12,841 --> 02:01:23,385 HAVE THE CORTICAL SPINAL TRACK. 3260 02:01:24,519 --> 02:01:26,421 AND THEY ARE APPROPRIATE TO THE 3261 02:01:26,421 --> 02:01:27,923 PRO PLEA AT MOTOR NEWERRANCE 3262 02:01:27,923 --> 02:01:28,223 WILL REMAIN. 3263 02:01:28,223 --> 02:01:29,658 WITHOUT THIS, THERE'S THE 3264 02:01:29,658 --> 02:01:31,126 MAINTENANCE OF REFLEX RADIATION 3265 02:01:31,126 --> 02:01:32,628 AND THAT'S SOMETHING THAT WE 3266 02:01:32,628 --> 02:01:34,796 ACTUALLY SEE IN KIDS WITH CP IS 3267 02:01:34,796 --> 02:01:37,766 THAT THEY HAVE MORE REFLEX 3268 02:01:37,766 --> 02:01:39,801 RADIATION AND STRONGER REFLEX 3269 02:01:39,801 --> 02:01:40,836 ACTIVITIES THAN YOU WOULD EXPECT 3270 02:01:40,836 --> 02:01:43,905 IN A TYPICALLY DEVELOPING CHILD. 3271 02:01:43,905 --> 02:01:47,909 SO THE FACTS THAT THESE AVENUER 3272 02:01:47,909 --> 02:01:48,610 ENTERS ARE NOT PRUNED IS 3273 02:01:48,610 --> 02:01:50,946 INDICATIVE OF A WEAKENED 3274 02:01:50,946 --> 02:01:52,247 CORTICAL SPINAL TRACT THAT IS 3275 02:01:52,247 --> 02:01:56,318 NOT KICKOFF SOME OF THE 3276 02:01:56,318 --> 02:02:03,959 DEVELOPMENTAL MINE STONES. 3277 02:02:03,959 --> 02:02:08,630 >> THE GOALS ARE FOCUSING ON THE 3278 02:02:08,630 --> 02:02:10,165 SPINAL CORD AND AREAS THAT ARE 3279 02:02:10,165 --> 02:02:14,002 ALTERED DURING DEVELOPMENT IN 3280 02:02:14,002 --> 02:02:15,804 INDIVIDUALS AND MODEL ANIMAL 3281 02:02:15,804 --> 02:02:18,273 MADELS OF CP AND TO DEVELOP 3282 02:02:18,273 --> 02:02:19,474 BIOMARKERS AND TARGETS FOR 3283 02:02:19,474 --> 02:02:20,275 TREATMENT. 3284 02:02:20,275 --> 02:02:22,744 ULTIMATELY, MY GOAL IS TO FIND 3285 02:02:22,744 --> 02:02:23,912 PHARMACEUTICAL INTERCEPTIONS 3286 02:02:23,912 --> 02:02:25,747 THAT COULD REDUCE THE SEVERITY 3287 02:02:25,747 --> 02:02:28,216 OF MOTOR DYSFUNCTION AND I'M 3288 02:02:28,216 --> 02:02:30,786 USING ANIMAL MODELS, I HAVE TO 3289 02:02:30,786 --> 02:02:32,220 USE AN ANIMAL MODEL WITH 3290 02:02:32,220 --> 02:02:34,790 PROMINENT MOTOR DEFECTS TO 3291 02:02:34,790 --> 02:02:40,529 QUANTIFY THE EFFECTS AND THE 3292 02:02:40,529 --> 02:02:46,601 AMELIORATE I REMEMBA -- AND THEH 3293 02:02:46,601 --> 02:02:48,670 PEOPLE THAT HAVE CP SO I HAVE 3294 02:02:48,670 --> 02:02:51,707 COLLABORATORS WHO WORK WITH 3295 02:02:51,707 --> 02:02:53,475 PEOPLE, I EXCLUSIVELY WORK WITH 3296 02:02:53,475 --> 02:02:55,477 ANIMAL MODELS IN MY LAB. 3297 02:02:55,477 --> 02:02:57,946 SO LET'S TALK ABOUT ANIMAL 3298 02:02:57,946 --> 02:02:58,380 MODELS. 3299 02:02:58,380 --> 02:02:59,748 WHEN SOMEONE MENTIONS ANIMAL 3300 02:02:59,748 --> 02:03:01,717 MODELS IN A RESEARCH CONTEXT, 3301 02:03:01,717 --> 02:03:04,453 PROBABLY EVERYONE'S MIND GOES TO 3302 02:03:04,453 --> 02:03:04,686 RODENTS. 3303 02:03:04,686 --> 02:03:06,088 FOR A GOOD REASON. 3304 02:03:06,088 --> 02:03:07,856 RODENTS ARE GREAT ANIMAL MODELS 3305 02:03:07,856 --> 02:03:08,957 FOR MANY REASONS. 3306 02:03:08,957 --> 02:03:11,626 BUT THEY MAY NOT BE THE BEST 3307 02:03:11,626 --> 02:03:12,694 MODEL FOR CEREBRAL PALSY IN 3308 02:03:12,694 --> 02:03:14,696 LOOKING AT MOTOR DEFICITS. 3309 02:03:14,696 --> 02:03:18,300 AND THE REASON IS BECAUSE THE 3310 02:03:18,300 --> 02:03:19,835 RODENTS ARE POST NATAL BRAIN 3311 02:03:19,835 --> 02:03:22,637 DEVELOPERS SO IF YOU INFLICT AN 3312 02:03:22,637 --> 02:03:25,140 INJURY TO RECAPITULATE CEREBRAL 3313 02:03:25,140 --> 02:03:27,342 PALSY, MOST PEOPLE DO THAT ON 3314 02:03:27,342 --> 02:03:29,244 POST NATAL DAY 7 AND IT'S A WEEK 3315 02:03:29,244 --> 02:03:31,947 OF AGE POST NATALLY IS WHEN A 3316 02:03:31,947 --> 02:03:33,248 RODENT BRAIN RESEMBLES THE 3317 02:03:33,248 --> 02:03:35,951 DEVELOPMENTAL STAGE OF A PERRY 3318 02:03:35,951 --> 02:03:40,322 NATPERINATAL HUMAN. 3319 02:03:40,322 --> 02:03:41,857 THIS IS A GREAT MODEL TO LOOK AT 3320 02:03:41,857 --> 02:03:43,992 BUT IF YOU ARE LOOKING AT MOTOR 3321 02:03:43,992 --> 02:03:46,228 DEFICITS, MOST STUDIES DO EVEN 3322 02:03:46,228 --> 02:03:48,730 REPORT MO MOTOR DEFICITS AND THE 3323 02:03:48,730 --> 02:03:50,031 THAT DON'T REPORT DEFICITS 3324 02:03:50,031 --> 02:03:51,399 REPORT MILD DEFICITS. 3325 02:03:51,399 --> 02:03:54,736 THERE'S A LOSS OF GRIP STRENGTH, 3326 02:03:54,736 --> 02:03:56,838 THERE'S LOSS OF FINE MOTOR CON 3327 02:03:56,838 --> 02:03:58,373 DINNATIONS THAT I CAN'T RUN ON A 3328 02:03:58,373 --> 02:03:59,975 LADDER QUITE AS WELL. 3329 02:03:59,975 --> 02:04:00,842 I SLIP A FEW MORE TIMES. 3330 02:04:00,842 --> 02:04:01,910 THEY HAVE LESS TIME THEY CAN 3331 02:04:01,910 --> 02:04:05,347 SPEND ON A ROT OR ROD SO THERE 3332 02:04:05,347 --> 02:04:06,948 ARE FINE MOTOR PROBLEMS BUT 3333 02:04:06,948 --> 02:04:09,317 THERE'S NOTHING THAT YOU WOULD 3334 02:04:09,317 --> 02:04:18,059 LOOK AT AND SAY TH IS USE FOR 3335 02:04:18,059 --> 02:04:19,795 ANOTHER ANIMAL MADEL. 3336 02:04:19,795 --> 02:04:21,930 THERE'S NO OVER MUSCLE STIFFNESS 3337 02:04:21,930 --> 02:04:24,633 AND IT'S BECAUSE AT POST NATAL 3338 02:04:24,633 --> 02:04:26,268 DAY 7 WHEN THE BRAIN IS MOST 3339 02:04:26,268 --> 02:04:28,270 DEVELOPMENTALLY SIMILAR TO A 3340 02:04:28,270 --> 02:04:31,573 HUMAN BRAIN, PERINATALLY, 3341 02:04:31,573 --> 02:04:33,008 RODENTS ARE TODDLER STAGE. 3342 02:04:33,008 --> 02:04:35,110 ESSENTIALLY THEY'RE BEGINNING TO 3343 02:04:35,110 --> 02:04:36,211 WALK. 3344 02:04:36,211 --> 02:04:39,181 ADULT LIKE ROW COMEAU TIVE IS 3345 02:04:39,181 --> 02:04:41,316 POST NATAL DAY NINE BUT TWO DAYS 3346 02:04:41,316 --> 02:04:42,584 AFTER THIS THEY'RE BEGINNING 3347 02:04:42,584 --> 02:04:45,420 THAT THEY BEGINNING TO TRY TO 3348 02:04:45,420 --> 02:04:47,155 HAVE SUPPORT AT P2. 3349 02:04:47,155 --> 02:04:50,592 THIS IS NOT REALLY AN 3350 02:04:50,592 --> 02:04:51,293 APPROPRIATE MODEL. 3351 02:04:51,293 --> 02:04:53,094 WE NEED TO LOOK AT A MODEL WITH 3352 02:04:53,094 --> 02:04:56,064 A DEVELOPMENTAL TIMELINE THAT IS 3353 02:04:56,064 --> 02:04:57,499 MORE COMPARABLE TO HUMANS AND 3354 02:04:57,499 --> 02:05:02,204 THE RABBIT MODEL, I USE A RABID 3355 02:05:02,204 --> 02:05:04,172 PRENATAL MODEL IS A REALLY GO 3356 02:05:04,172 --> 02:05:06,808 AHEAD ONE BECAUSE RABBITS ARE 3357 02:05:06,808 --> 02:05:09,778 PERINATAL BRAIN DEVELOPERS LIKE 3358 02:05:09,778 --> 02:05:12,681 HUMANS AND YOU CAN EXERT THE 3359 02:05:12,681 --> 02:05:17,052 SYSTEM PRE-NATALLY SO I USE 70% 3360 02:05:17,052 --> 02:05:18,487 OR 80% GESTATION AND THEN YOU 3361 02:05:18,487 --> 02:05:20,589 CAN LOOK AT THE POST NATAL 3362 02:05:20,589 --> 02:05:24,192 DEVELOPMENT OF LOCOMOTION WHICH 3363 02:05:24,192 --> 02:05:25,727 IS ANOTHER PARALLEL IN THE 3364 02:05:25,727 --> 02:05:27,996 TIMELINE TO HUMAN 3365 02:05:27,996 --> 02:05:28,363 DEVELOPINGMENT. 3366 02:05:28,363 --> 02:05:29,865 THE INJURY OCCURS DURING THE 3367 02:05:29,865 --> 02:05:31,266 DEVELOPMENT OF THE CORTICAL 3368 02:05:31,266 --> 02:05:33,401 SPINAL PROJECTIONS SO IN TA 3369 02:05:33,401 --> 02:05:34,736 TARGET AREA I WAS MENTIONING IN 3370 02:05:34,736 --> 02:05:36,771 THE TIMELINE OF THE GENERAL 3371 02:05:36,771 --> 02:05:38,306 MOVEMENTS AND IT'S SIMILAR TO 3372 02:05:38,306 --> 02:05:40,375 HUMANS AND THIS IS AFTER THE 3373 02:05:40,375 --> 02:05:41,476 ESTABLISHMENT OF PROJECTIONS TO 3374 02:05:41,476 --> 02:05:43,111 THE SPINAL CORD LIKE IN HUMANS. 3375 02:05:43,111 --> 02:05:45,247 AS YOU CAN SEE FROM THIS PHOTO, 3376 02:05:45,247 --> 02:05:48,049 THIS IS A NEONATAL DAY ONE 3377 02:05:48,049 --> 02:05:50,418 RABBIT KIT AND IT'S DISPLAYING 3378 02:05:50,418 --> 02:05:52,654 STIFF MUSCLES IN ITS FORELIMB. 3379 02:05:52,654 --> 02:05:55,657 YOU CAN SEE THE STIFFNESS IS 3380 02:05:55,657 --> 02:05:57,559 CHANGING THE POSTURE OF THAT 3381 02:05:57,559 --> 02:06:01,096 FORELIMB AND WE SEE A VARIABLE 3382 02:06:01,096 --> 02:06:04,065 NUMBER OF LIMBS EFFECTED IN KITS 3383 02:06:04,065 --> 02:06:14,409 AFTER HI HYPOXIA HE IS KEEPIA SO 3384 02:06:14,409 --> 02:06:15,710 IT'S UNEFFECTED IF THEY DON'T 3385 02:06:15,710 --> 02:06:17,212 HAVE STIFFNESS IN THE LIMBS. 3386 02:06:17,212 --> 02:06:24,786 OVER ALL WE SEE THAT THE WHITE 3387 02:06:24,786 --> 02:06:30,025 MATTER AND THE OUTCOMES ARE ALSO 3388 02:06:30,025 --> 02:06:31,259 VERY SIMILAR. 3389 02:06:31,259 --> 02:06:32,994 RABBITS IN THE LAST PICTURE HAVE 3390 02:06:32,994 --> 02:06:36,331 STIFF MUSCLES AND THEY HAVE 3391 02:06:36,331 --> 02:06:37,966 HYPER REFLEXIA AND THERE'S A 3392 02:06:37,966 --> 02:06:41,169 REDUCTION IN THE RATE DEPENDENT 3393 02:06:41,169 --> 02:06:43,338 DEPRESSION OF REFLEX IN HUMANS. 3394 02:06:43,338 --> 02:06:47,008 THIS WAS FOUND TO BE THE MOST 3395 02:06:47,008 --> 02:06:48,310 ACCURATE PREDICTER OF SASS 3396 02:06:48,310 --> 02:06:50,278 ADVERTISE TEE AND THERE'S ALSO A 3397 02:06:50,278 --> 02:06:57,519 MAINTENANCE OF REFLEXER 3398 02:06:57,519 --> 02:07:07,696 RADIATION. 3399 02:07:10,699 --> 02:07:14,336 OVER ALL THE RABBIT IS AN IDEAL 3400 02:07:14,336 --> 02:07:15,870 MODEL TO DO THIS PRE CLINICAL 3401 02:07:15,870 --> 02:07:16,905 DEVELOPMENT OF TREATMENTS. 3402 02:07:16,905 --> 02:07:18,139 SO LET'S TAKE A LOOK. 3403 02:07:18,139 --> 02:07:23,612 WHAT ARE SOME OF THE PROMISING 3404 02:07:23,612 --> 02:07:24,512 PHARMACEUTICAL. 3405 02:07:24,512 --> 02:07:28,683 I WANT TO EMPHASIS I'M A SPINAL 3406 02:07:28,683 --> 02:07:30,185 CORD PHYSICALLOLOGIST, I THINK 3407 02:07:30,185 --> 02:07:31,886 THE SPINAL CORD HAS BEEN 3408 02:07:31,886 --> 02:07:33,288 OVERLOOKED IN RESEARCH. 3409 02:07:33,288 --> 02:07:35,657 CERTAINLY THE BRAIN INJURY 3410 02:07:35,657 --> 02:07:38,793 POSITIVE OF CEREBRAL PALSY BUT 3411 02:07:38,793 --> 02:07:39,728 DEVELOP YOU ARE NEURONS IN THE 3412 02:07:39,728 --> 02:07:40,795 BRAIN ARE NOT THE ONLY ONES THAT 3413 02:07:40,795 --> 02:07:44,065 ARE SENSITIVE TO A GLOBAL INSULT 3414 02:07:44,065 --> 02:07:49,337 LIKE NEURO INFLAMMATION AND THEY 3415 02:07:49,337 --> 02:07:51,573 CAN BE EQUALLY AS VULNERABLE TO 3416 02:07:51,573 --> 02:07:53,375 DEATH SO AFTER HIGH POX' 3417 02:07:53,375 --> 02:07:54,676 ISCHEMIA IN THE RABBIT AND IN 3418 02:07:54,676 --> 02:07:57,245 FACT IT'S BEEN DETECTED IN 3419 02:07:57,245 --> 02:07:58,913 POSTMORTEM SAMPLES IN THE SPINAL 3420 02:07:58,913 --> 02:08:00,415 CORD OF HUMANS AND WHO HAVE DIED 3421 02:08:00,415 --> 02:08:10,892 FROM HYPOXIA, AT BIRTH, THAT 3422 02:08:11,459 --> 02:08:14,996 THERE'S IT'S 3423 02:08:14,996 --> 02:08:17,465 IN THE SPINAL GRAY MATTER AS I 3424 02:08:17,465 --> 02:08:19,234 MENTIONED IN THE LAST SLIDE 3425 02:08:19,234 --> 02:08:21,236 THERE'S A REDUCED NUMBER OF 3426 02:08:21,236 --> 02:08:22,537 SPINAL MOTOR NEURONS. 3427 02:08:22,537 --> 02:08:23,438 ANOTHER THING WE FOUND IS A 3428 02:08:23,438 --> 02:08:24,506 LITTLE BIT OF A SURPRISE IS 3429 02:08:24,506 --> 02:08:31,846 THERE WAS AN EXPANSION IN THE 3430 02:08:31,846 --> 02:08:32,681 AFFERENTS. 3431 02:08:32,681 --> 02:08:36,251 SO THERE'S A SIGNIFICANT 3432 02:08:36,251 --> 02:08:39,054 EXPANSION IN INVASION INTO THE 3433 02:08:39,054 --> 02:08:43,191 IT COULD BE RELATED TO PRUNING 3434 02:08:43,191 --> 02:08:45,827 OF THE AFFERENTS AT FIRST. 3435 02:08:45,827 --> 02:08:47,495 THIS IS AN AREA THAT I'M VERY 3436 02:08:47,495 --> 02:08:48,830 INTERESTED IN PURSUING. 3437 02:08:48,830 --> 02:08:50,432 IT ALSO CAN BE RELATED TO THE 3438 02:08:50,432 --> 02:08:53,034 HIGH DEGREE OF CO-MORBIDITY WE 3439 02:08:53,034 --> 02:08:54,002 SEE IN CEREBRAL PALSY PATIENTS 3440 02:08:54,002 --> 02:09:00,975 WITH PAIN, CHRONIC PAIN IS A 3441 02:09:00,975 --> 02:09:04,212 FREQUENT OCCURRENCE. 3442 02:09:04,212 --> 02:09:10,018 THE PHO FOCUS TODAY IS SEROTONI. 3443 02:09:10,018 --> 02:09:15,190 IT INDICATED HERE BY THIS BLACK 3444 02:09:15,190 --> 02:09:17,192 SPROUT OF THE FIBERS AND THIS IS 3445 02:09:17,192 --> 02:09:18,626 ACCOMPANIED BY AN INCREASE IN 3446 02:09:18,626 --> 02:09:20,762 THE SEROTONIN CONCENTRATION IN 3447 02:09:20,762 --> 02:09:23,364 THE SPINAL CORD SO BOTH CERVICAL 3448 02:09:23,364 --> 02:09:25,166 AND LUMBAR A CORDS SHOW HIGHER 3449 02:09:25,166 --> 02:09:28,703 LEVELS OF SEROTONIN AND THIS IS 3450 02:09:28,703 --> 02:09:30,572 SOMETHING THAT IS VOLUME 3451 02:09:30,572 --> 02:09:32,507 TRANSMISSIONS SO AN INCREASE IN 3452 02:09:32,507 --> 02:09:35,743 THE SEROTONIN IN THE SPINAL CORD 3453 02:09:35,743 --> 02:09:38,413 COULD BE A BIG DEAL IN HOW IT 3454 02:09:38,413 --> 02:09:41,249 EFFECTS DEVELOPING NEURONS. 3455 02:09:41,249 --> 02:09:42,817 SO, IS IT A BIG DEAL? 3456 02:09:42,817 --> 02:09:43,985 IN FACT, IT IS. 3457 02:09:43,985 --> 02:09:46,020 IT'S ABSOLUTELY RELATED INFORM 3458 02:09:46,020 --> 02:09:47,956 THE MUSCLE STIFFNESS DIRECTLY 3459 02:09:47,956 --> 02:09:51,159 AND YOU CAN BLOCK SEROTONIN 3460 02:09:51,159 --> 02:09:54,496 RECEPTORS IN THE SPINAL CORD 3461 02:09:54,496 --> 02:10:00,535 USING A 5HT2 AND 5HD1 RECEPTORS 3462 02:10:00,535 --> 02:10:03,772 BLOCKER AND IT REDUCES STIFFNESS 3463 02:10:03,772 --> 02:10:04,939 SO RABBITS THAT HAD STIFF 3464 02:10:04,939 --> 02:10:09,644 MUSCLES HAVE REDUCED STIFFNESS 3465 02:10:09,644 --> 02:10:12,347 AFTER TREATMENT WITH 3466 02:10:12,347 --> 02:10:13,114 METHISERGIDE AND THERE'S NO 3467 02:10:13,114 --> 02:10:15,817 CHANGE IN THE STIFFNESS USING OF 3468 02:10:15,817 --> 02:10:17,685 A MEASUREMENT OF JOINT TORQUE 3469 02:10:17,685 --> 02:10:21,122 AND SO WE SEE THAT HYPOXY 3470 02:10:21,122 --> 02:10:23,858 ISCHEMIA CAN INCREASE LEVELS OF 3471 02:10:23,858 --> 02:10:26,561 SEROTONIN BUT IS THAT AN 3472 02:10:26,561 --> 02:10:28,763 BLOCKING IT, IS EFFECTIVE AT 3473 02:10:28,763 --> 02:10:29,898 REDUCING STIFFNESS OF THE 3474 02:10:29,898 --> 02:10:30,131 MUSCLES? 3475 02:10:30,131 --> 02:10:33,368 COULD IT BE THAT SEROTONIN AND 3476 02:10:33,368 --> 02:10:35,470 NOT THE HYPOXY ISCHEMIA IS 3477 02:10:35,470 --> 02:10:37,038 DRIVING MUSCLE STIFFNESS? 3478 02:10:37,038 --> 02:10:38,940 EARLY RESULTS FROM MY LAB 3479 02:10:38,940 --> 02:10:41,910 INDICATES THAT IT COULD BE. 3480 02:10:41,910 --> 02:10:45,446 INSTEAD OF HYPOXY ISCHEMIA, 3481 02:10:45,446 --> 02:10:50,485 THERE ARE A FEW PREGNANT RABBIT 3482 02:10:50,485 --> 02:10:53,755 DAMNS RELEASING SEROTONIN AND SO 3483 02:10:53,755 --> 02:10:56,558 JUST BY BOOSTING THE LEVEL OF 3484 02:10:56,558 --> 02:10:58,993 SEROTONIN IN SOME OF THESE KITS, 3485 02:10:58,993 --> 02:11:01,963 THEY HAVE AN INCREASED LEVEL OF 3486 02:11:01,963 --> 02:11:02,297 GIANT TORQUE. 3487 02:11:02,297 --> 02:11:05,133 AND INDICATING THAT MUSCLE 3488 02:11:05,133 --> 02:11:08,803 STIFFNESS IS DRIVEN BY SEROTONIN 3489 02:11:08,803 --> 02:11:12,607 ALONE WITHOUT THE HIGH TOX' HYPY 3490 02:11:12,607 --> 02:11:13,875 ISCHEMIA SO IT'S SOMETHING I 3491 02:11:13,875 --> 02:11:15,310 FIND VERY FASCINATEING AND IF 3492 02:11:15,310 --> 02:11:17,212 WORE GOING TO LOOK AT 3493 02:11:17,212 --> 02:11:18,246 PHARMACEUTICAL TREATMENTS BASED 3494 02:11:18,246 --> 02:11:22,150 ON SARAH TON INWE NEED TO KNOW 3495 02:11:22,150 --> 02:11:23,484 WHAT RECEPTORS SUB TYPES ARE 3496 02:11:23,484 --> 02:11:24,886 THERE AND HOW THIS IS EKKAPOL 3497 02:11:24,886 --> 02:11:29,224 CHANEFFECTING CELLS INTHE SPINAE 3498 02:11:29,224 --> 02:11:31,025 THERE ARE NO UNEXPECTED 3499 02:11:31,025 --> 02:11:31,526 OCCURRENCES. 3500 02:11:31,526 --> 02:11:34,562 SO I RECORDED FROM MOTOR NEURONS 3501 02:11:34,562 --> 02:11:36,664 AND THIS IS A CONTROL RABBIT 3502 02:11:36,664 --> 02:11:38,099 MOTOR NEURON AND INJECT AND I 3503 02:11:38,099 --> 02:11:40,468 CAN TELL THE INPUT AND OUTPUT 3504 02:11:40,468 --> 02:11:41,903 RELATIONSHIP BECAUSE THE MOTOR 3505 02:11:41,903 --> 02:11:46,808 NEURON WILL START FIRING AT A 3506 02:11:46,808 --> 02:11:48,443 CERTAIN AMOUNT OF CURRENT. 3507 02:11:48,443 --> 02:11:50,144 INTERESTINGLY ENOUGH, WHEN I PUT 3508 02:11:50,144 --> 02:11:54,716 SESEROTONIN IN THE BAT, THE MOTR 3509 02:11:54,716 --> 02:11:56,784 NEURONS ARE UNEFFECTED. 3510 02:11:56,784 --> 02:12:00,221 THIS IS IN CONTRAST TO AN HI 3511 02:12:00,221 --> 02:12:03,391 AFFECTED MOTOR KNEW ON AND THERE 3512 02:12:03,391 --> 02:12:05,793 IS A BIG CHANGE IN THE AMOUNT OF 3513 02:12:05,793 --> 02:12:08,263 CURRENT NEEDED TO ILLICIT ACTION 3514 02:12:08,263 --> 02:12:10,431 POTENTIALS AND A BIG CHANGE IN 3515 02:12:10,431 --> 02:12:15,236 THE THRESHOLD TO OVER ALL IF WE 3516 02:12:15,236 --> 02:12:16,638 LOOK, WE CAN COMPARE A CONTROL 3517 02:12:16,638 --> 02:12:18,106 MOTOR NEURONS IN THE BLUE BEFORE 3518 02:12:18,106 --> 02:12:19,974 AND AFTER AND THERE'S NO 3519 02:12:19,974 --> 02:12:22,010 SIGNIFICANT CHANGE IN REAL BASED 3520 02:12:22,010 --> 02:12:23,411 OR THRESHOLD BUT IF YOU LOOK AT 3521 02:12:23,411 --> 02:12:26,814 THE PINK AND RED TRACES THEY ARE 3522 02:12:26,814 --> 02:12:28,449 UNEFFECTED WITH STIFF MUSCLES OR 3523 02:12:28,449 --> 02:12:31,552 EFFECTED AND IN BOTH CASES, THEY 3524 02:12:31,552 --> 02:12:35,223 ARE SUPER SENSITIVE SO HI HAS 3525 02:12:35,223 --> 02:12:37,692 SOME EFFECT ON THE MOTOR NEURONS 3526 02:12:37,692 --> 02:12:42,797 OF CREATING SUPER SENSITIVITY TO 3527 02:12:42,797 --> 02:12:43,598 SEROTONIN. 3528 02:12:43,598 --> 02:12:46,067 SO, I WILL TAKE IT TO THE NEXT 3529 02:12:46,067 --> 02:12:47,835 LEVEL, I WANT TO SEE WHAT 3530 02:12:47,835 --> 02:12:49,937 SEROTONIN RECEPTORS ARE THERE IN 3531 02:12:49,937 --> 02:12:50,872 MEDIATING THIS. 3532 02:12:50,872 --> 02:12:54,809 THE FIRST ONE TO LOOK AT IS 5HT 3533 02:12:54,809 --> 02:12:55,643 RECEPTOR. 3534 02:12:55,643 --> 02:12:57,245 THEY'RE DESCRIBED IN ADULT MOTOR 3535 02:12:57,245 --> 02:12:59,147 NEURONS AND ADULT HUMANS WE KNOW 3536 02:12:59,147 --> 02:13:00,415 THAT THEY INCREASE EXCITE 3537 02:13:00,415 --> 02:13:02,550 ABILITY OF MOTOR NEURONS SO IN 3538 02:13:02,550 --> 02:13:04,085 OUR FIRST PASS, THIS IS JUST 3539 02:13:04,085 --> 02:13:06,287 PRELIMINARY DATA LOOKING AT 3540 02:13:06,287 --> 02:13:09,123 NEURONS IN THE VENTRAL CORD AND 3541 02:13:09,123 --> 02:13:11,259 WHERE MOTOR NEURONS ARE KNOWN TO 3542 02:13:11,259 --> 02:13:13,194 RESIDE THERE'S MORE STANDING OF 3543 02:13:13,194 --> 02:13:13,428 NEURONS. 3544 02:13:13,428 --> 02:13:15,730 IN THE HI SPINAL CORDS. 3545 02:13:15,730 --> 02:13:17,765 THIS IS A LIGHT BLUE VERSUS DARK 3546 02:13:17,765 --> 02:13:21,069 BLUE SO THERE ARE MORE NEURONS 3547 02:13:21,069 --> 02:13:26,674 IN GENERAL AND MOTOR NEURONS AND 3548 02:13:26,674 --> 02:13:30,712 POSITIVE FOR 5H2A MANY OF THE 3549 02:13:30,712 --> 02:13:32,413 5H1A IS INHIBITORY AND MEDIATES 3550 02:13:32,413 --> 02:13:34,649 NEURAL FATIGUE SO IT SHUTS DOWN 3551 02:13:34,649 --> 02:13:36,084 ACTIVITY IN THE MOTOR NEURONS 3552 02:13:36,084 --> 02:13:38,720 AND AS YOU CAN SEE FROM THE 3553 02:13:38,720 --> 02:13:39,921 SHAM, THE SPINAL CORDS, WE'RE 3554 02:13:39,921 --> 02:13:44,692 LOOKING AT THE VENTERRAL LATERAL 3555 02:13:44,692 --> 02:13:46,828 WHERE THE MOTOR NEURONS ARE 3556 02:13:46,828 --> 02:13:47,061 LOCATED. 3557 02:13:47,061 --> 02:13:48,062 THEY'RE STAYING GREEN AND THE 3558 02:13:48,062 --> 02:13:49,964 RED RING AROUND THE MOTOR 3559 02:13:49,964 --> 02:13:51,532 NEURONS INDICATES AN EXPRESSION 3560 02:13:51,532 --> 02:13:55,436 OF 5H21A RECEPTORS ON THE 3561 02:13:55,436 --> 02:13:56,104 MEMBRANE OF THE SHAM CONTROL 3562 02:13:56,104 --> 02:13:57,205 MOTOR NEURONS. 3563 02:13:57,205 --> 02:13:59,540 THAT RING OF RED STAINING IS 3564 02:13:59,540 --> 02:14:02,643 REALLY ABSENT WHEN WE LOOK IN 3565 02:14:02,643 --> 02:14:05,046 THE H1 MOTOR NEURONS. 3566 02:14:05,046 --> 02:14:06,714 INDICATING THAT THERE'S A LOSS 3567 02:14:06,714 --> 02:14:11,119 IN EXPRESSION OF THE 5H IT 1A 3568 02:14:11,119 --> 02:14:11,552 RECEPTORS. 3569 02:14:11,552 --> 02:14:13,688 SO, TO SUMMARIZE, IT SEEMS THAT 3570 02:14:13,688 --> 02:14:16,791 CONTROL MOTOR NEURONS IN THE 3571 02:14:16,791 --> 02:14:20,094 NEONATAL RABBIT HAVE AN OVER 3572 02:14:20,094 --> 02:14:25,066 ABUNDANCE OF 5HTA1 AND THEY 3573 02:14:25,066 --> 02:14:26,267 DOMINATE THE SEROTONIN BUT MUCH 3574 02:14:26,267 --> 02:14:28,836 OF THE RESPONSE IN NEONATES WILL 3575 02:14:28,836 --> 02:14:34,575 BE MIXED INHIBIT EXCITED AND NO 3576 02:14:34,575 --> 02:14:36,911 NET RESPONSE WHERE AN HI MOTOR 3577 02:14:36,911 --> 02:14:39,280 NEURON AND 2A RE SCEPTER MAY BE 3578 02:14:39,280 --> 02:14:42,316 THE DOMINANT RECEPTORS THAT 3579 02:14:42,316 --> 02:14:45,053 WE'RE HITTING WITH INCREASED 3580 02:14:45,053 --> 02:14:46,054 SEROTONIN. 3581 02:14:46,054 --> 02:14:47,789 AND 5H IT RE SCEPTER ACTIVATION 3582 02:14:47,789 --> 02:14:49,323 IN THESE MOTOR NEURONS WOULD 3583 02:14:49,323 --> 02:14:52,193 MEAN IT AMPLIFIES AND POST 3584 02:14:52,193 --> 02:14:54,562 POTENTIALS AND AMPLIFYING 3585 02:14:54,562 --> 02:14:56,264 INTRINSIC PERSIST APARTMENT AND 3586 02:14:56,264 --> 02:14:57,865 RECURRENCE THAT INCREASES EXCITE 3587 02:14:57,865 --> 02:14:59,867 ABILITY OF THE MOTOR NEURONS. 3588 02:14:59,867 --> 02:15:04,138 SO TO SUM SUMMARIZE, I THINK TE 3589 02:15:04,138 --> 02:15:06,140 BEEN OVERLOOKED FOR FAR TOO LONG 3590 02:15:06,140 --> 02:15:08,643 AND THEY'RE ALSO ENTERED IN 3591 02:15:08,643 --> 02:15:11,145 EFFECTIVE HYPOXY ISCHEMIA AND 3592 02:15:11,145 --> 02:15:12,447 OTHER GLOBAL INSULTS IT'S NOT 3593 02:15:12,447 --> 02:15:13,514 JUST THE BRAIN. 3594 02:15:13,514 --> 02:15:17,885 THE SPINAL SEROTONIN INCREASES 3595 02:15:17,885 --> 02:15:19,454 AFTER INJURY IN THE DEVELOPING 3596 02:15:19,454 --> 02:15:21,089 SPINAL CORD AND THIS COULD BE 3597 02:15:21,089 --> 02:15:23,591 VERY IMPORTANT BECAUSE BLOCKING 3598 02:15:23,591 --> 02:15:27,528 IT REDUCES HYPER TONIA AND 3599 02:15:27,528 --> 02:15:29,297 ACUTELY AND CHRONICALLY 3600 02:15:29,297 --> 02:15:31,766 INCREASING SEROTONIN USING SSRI 3601 02:15:31,766 --> 02:15:36,604 IS SUFFICIENT WITHOUT HYPOXIA TO 3602 02:15:36,604 --> 02:15:40,374 INDUCE HYPER TONIA AND THERE'S 3603 02:15:40,374 --> 02:15:43,311 5HD2 AND RECEPTORS AFTER HI 3604 02:15:43,311 --> 02:15:44,979 BASED ON OUR PRELIMINARY DATA SO 3605 02:15:44,979 --> 02:15:47,048 IN THE FUTURE I'M GOING TO LOOK 3606 02:15:47,048 --> 02:15:57,592 MORE CLOSELY AT WHETHER BLOCKING 3607 02:16:01,295 --> 02:16:03,030 I WANT TO THANK MY LAB FOR 3608 02:16:03,030 --> 02:16:03,931 HELPING WITH THIS WORK. 3609 02:16:03,931 --> 02:16:06,434 THIS IS A PICTURE OF MY LAB. 3610 02:16:06,434 --> 02:16:09,971 MY POSTDOC EMILY DID THE WORK. 3611 02:16:09,971 --> 02:16:16,978 AND MY OTHER TALENTED POSTDOC 3612 02:16:16,978 --> 02:16:18,146 AND CLASSIFYING SOME OF THE 3613 02:16:18,146 --> 02:16:19,180 RADIATION AND THINGS WE DIDN'T 3614 02:16:19,180 --> 02:16:24,118 HAVE TIME TO TALK ABOUT TODAY. 3615 02:16:24,118 --> 02:16:26,254 WE LOOK AT PEOPLE WITH CP AND 3616 02:16:26,254 --> 02:16:27,522 HELPS VERIFY WHAT WE'RE SEEING 3617 02:16:27,522 --> 02:16:28,956 IN THE ANIMALS IS SOMETHING THAT 3618 02:16:28,956 --> 02:16:31,893 IS RELIABLE IN PATIENT 3619 02:16:31,893 --> 02:16:33,794 POPULATIONS AND MY COLLABORATION 3620 02:16:33,794 --> 02:16:36,497 AND I'M CONVINCE TODAY HELP ME 3621 02:16:36,497 --> 02:16:38,132 IN THIS EVERY DOWN AND LOOKING 3622 02:16:38,132 --> 02:16:40,968 AT MOTOR UNIT DEVELOPMENT IN THE 3623 02:16:40,968 --> 02:16:44,839 SPINAL CORD OF THESE RABBITS. 3624 02:16:44,839 --> 02:16:45,406 THANK YOU. 3625 02:16:45,406 --> 02:16:48,142 >> GOOD MORNING, I'M Dr. GNAT 3626 02:16:48,142 --> 02:16:50,678 ALI MAITRE FROM EMILY AND 3627 02:16:50,678 --> 02:16:52,446 CHILDREN'S HEALTHCARE OF AT LAN 3628 02:16:52,446 --> 02:16:54,649 TA AND THE DIRECTOR OF EARLY 3629 02:16:54,649 --> 02:16:56,317 DEVELOPMENT AND CEREBRAL PALSY 3630 02:16:56,317 --> 02:16:56,651 RESEARCH. 3631 02:16:56,651 --> 02:16:58,386 I'M THRILLED TO BE HERE TO TALK 3632 02:16:58,386 --> 02:17:01,889 TO YOU TODAY ABOUT SOME OF OUR 3633 02:17:01,889 --> 02:17:03,891 RESEARCH AND THE PRIORITIES WE 3634 02:17:03,891 --> 02:17:05,593 SEE BEING IMPORTANT IN CEREBRAL 3635 02:17:05,593 --> 02:17:08,863 PALSY RESEARCH IN THE FUTURE. 3636 02:17:08,863 --> 02:17:10,665 THOSE KEY POINTS FOR CP RESEARCH 3637 02:17:10,665 --> 02:17:13,935 AT LEAST IN INFANCY, ARE TO 3638 02:17:13,935 --> 02:17:16,537 FOCUS ON SCIENTIFICALLY SOUND 3639 02:17:16,537 --> 02:17:18,406 RESEARCH SO MECHANISTICALLY 3640 02:17:18,406 --> 02:17:22,009 BASED, BOTH SAFE AND EFFECTIVE 3641 02:17:22,009 --> 02:17:23,444 RESEARCH IMPLEMENTABLE AND 3642 02:17:23,444 --> 02:17:30,952 IMPLEMENTED RESEARCH. 3643 02:17:30,952 --> 02:17:37,191 ILLINOILLINOIS STRAIGHT A STORYD 3644 02:17:37,191 --> 02:17:39,093 ICHD AND THIS IS CALLED APPLES, 3645 02:17:39,093 --> 02:17:41,262 A POSITIVE PARENT-FOCUSED 3646 02:17:41,262 --> 02:17:42,964 TRAINING FOR UPPER LIMB 3647 02:17:42,964 --> 02:17:45,499 EXPERIENCE WITH SENSORY MOTOR 3648 02:17:45,499 --> 02:17:45,766 FEEDBACK. 3649 02:17:45,766 --> 02:17:48,402 YOU WILL SEE THAT MY YOUNG 3650 02:17:48,402 --> 02:17:53,874 PATIENTS, MUCH LIKE THE APELS IS 3651 02:17:53,874 --> 02:17:57,278 IN THIS PICTURE ARE NUMEROUS AND 3652 02:17:57,278 --> 02:17:57,511 DIVERSE. 3653 02:17:57,511 --> 02:17:59,313 WHEN WE DESIGN INTERVENTIONS AND 3654 02:17:59,313 --> 02:18:01,415 WE TEST THEM, IN INFANTS WHO 3655 02:18:01,415 --> 02:18:04,252 HAVE CP VERY YOUNG, WE FACE 3656 02:18:04,252 --> 02:18:06,687 CERTAIN CHALLENGES THAT ARE 3657 02:18:06,687 --> 02:18:09,757 DIFFERENT THAN THOSE IN ADULT CP 3658 02:18:09,757 --> 02:18:10,124 RESEARCH. 3659 02:18:10,124 --> 02:18:12,860 WE'RE DEALING WITH RECENT 3660 02:18:12,860 --> 02:18:14,528 PERINATAL NURRAL INSULTS, MANY 3661 02:18:14,528 --> 02:18:18,065 OF THEM DUE TO PREMATURITY BUT 3662 02:18:18,065 --> 02:18:19,267 ALSO STROKE AND HIA. 3663 02:18:19,267 --> 02:18:23,804 THESE CAUSE A SYMMETRIC FORMS OF 3664 02:18:23,804 --> 02:18:25,740 CEREBRAL PALSY WHICH MEANS THIS 3665 02:18:25,740 --> 02:18:30,645 COULD BE OF A HEMOLPEGIA AND A 3666 02:18:30,645 --> 02:18:32,279 QUAD DRANK PLEDGE A, BOTH CAN 3667 02:18:32,279 --> 02:18:35,116 RESULT IN NON USE OF A MORE 3668 02:18:35,116 --> 02:18:37,585 EFFECTED HAND AND ARM. 3669 02:18:37,585 --> 02:18:40,288 THE LACK OF TYPICAL USE OF AN 3670 02:18:40,288 --> 02:18:42,490 ARM, AND THE LACK OF SENSORY 3671 02:18:42,490 --> 02:18:43,691 FEEDBACK TO THAT EXTREMITY 3672 02:18:43,691 --> 02:18:47,461 DURING A CRITICAL PERIOD, 3673 02:18:47,461 --> 02:18:48,896 ESPECIALLY VERY EARLY, CAN LEAD 3674 02:18:48,896 --> 02:18:50,464 TO A LOT TERRATIONS IN 3675 02:18:50,464 --> 02:18:53,601 DEVELOPMENT OF ASSOCIATED 3676 02:18:53,601 --> 02:18:55,369 FUNCTIONS BOTH MOTOR AND SENSORY 3677 02:18:55,369 --> 02:18:56,070 WELL INTO ADULTHOOD. 3678 02:18:56,070 --> 02:18:58,205 WE KNOW SOME OF THIS CAN HAPPEN 3679 02:18:58,205 --> 02:19:01,275 IN YOUNG INFANTS OR CHILDREN 3680 02:19:01,275 --> 02:19:02,309 WITH CEREBRAL PALSY. 3681 02:19:02,309 --> 02:19:04,311 THIS HAS BEEN SOME OF THE WORK 3682 02:19:04,311 --> 02:19:08,983 OF Dr. MATIRE SHOWING NEURAL 3683 02:19:08,983 --> 02:19:10,785 GENERATES IN THE BRAIN AND 3684 02:19:10,785 --> 02:19:14,455 STIMULI CAN BE ALTERED WHEN 3685 02:19:14,455 --> 02:19:16,123 CHILDREN ARE DEPRIVED OF SENSORY 3686 02:19:16,123 --> 02:19:19,527 FEEDBACK TO A LESS EFFECTED 3687 02:19:19,527 --> 02:19:20,561 EXTREMITY. 3688 02:19:20,561 --> 02:19:22,963 WE ALSO HAVE CHALLENGES IN 3689 02:19:22,963 --> 02:19:24,632 DESIGNING INTERVENTIONS AND THE 3690 02:19:24,632 --> 02:19:28,502 FACT THAT INFANT ENDURANCE AND 3691 02:19:28,502 --> 02:19:29,470 LEARNING CAPACITY ARE 3692 02:19:29,470 --> 02:19:31,272 NECESSARILY LIMITED BY 3693 02:19:31,272 --> 02:19:33,841 DEVELOPMENTAL PROCESSES. 3694 02:19:33,841 --> 02:19:36,711 WE ALSO FACE ANOTHER CHALLENGE. 3695 02:19:36,711 --> 02:19:38,979 WHICH IS THAT A YOUNG INFANT, 3696 02:19:38,979 --> 02:19:42,283 WITH CP, IS NOT JUST THE SINGLE 3697 02:19:42,283 --> 02:19:43,718 PATIENT THAT WE TREAT. 3698 02:19:43,718 --> 02:19:47,521 WE ARE ACTUALLY TREATING A 3699 02:19:47,521 --> 02:19:48,589 PARENT-CHILD DIALECT IN THE 3700 02:19:48,589 --> 02:19:50,524 SELF-CAPACITY IN THE LONG-TERM 3701 02:19:50,524 --> 02:19:54,228 OF THAT PARENT/CHILD DIE ADD 3702 02:19:54,228 --> 02:19:57,164 DEPENDS ON THAT STABLE AND 3703 02:19:57,164 --> 02:19:58,065 EMPOWERED RELATIONSHIP. 3704 02:19:58,065 --> 02:20:00,067 SO WITH ALL OF THESE CHALLENGES 3705 02:20:00,067 --> 02:20:03,237 IN MIND, HOW DID WE DESIGN AN 3706 02:20:03,237 --> 02:20:12,947 INTERVENTION AND TEST IT? 3707 02:20:12,947 --> 02:20:14,582 WE USED SCIENTIFIC SOUND BASIS 3708 02:20:14,582 --> 02:20:22,256 AND THIS IS FROM MY COLLEAGUES. 3709 02:20:22,256 --> 02:20:24,058 I WANT TO SHOWCASE THEIR WORK 3710 02:20:24,058 --> 02:20:25,826 AND HOW IT LED TO THE 3711 02:20:25,826 --> 02:20:28,062 DEVELOPMENT OF THIS 3712 02:20:28,062 --> 02:20:28,396 INTERVENTION. 3713 02:20:28,396 --> 02:20:29,964 WE USED A SOFT CONSTRAINTS AND 3714 02:20:29,964 --> 02:20:31,532 WE KNEW WE NEEDED A CERTAIN 3715 02:20:31,532 --> 02:20:34,201 DOSAGE OF IT, THANKS TO THE WORK 3716 02:20:34,201 --> 02:20:38,239 OF DOCTORS. 3717 02:20:38,239 --> 02:20:43,611 WE KN KNEW REACH TRAINING CAN 3718 02:20:43,611 --> 02:20:50,017 PROMOPROMOTES SUCCESS THROUGH SY 3719 02:20:50,017 --> 02:20:50,484 MITTENS. 3720 02:20:50,484 --> 02:20:52,920 SENSORY MOTOR TRAINING WAS 3721 02:20:52,920 --> 02:20:56,557 INSPIRED BY THE WORK OF Dr. 3722 02:20:56,557 --> 02:21:00,194 HEATH COCK AND FRIEL. 3723 02:21:00,194 --> 02:21:01,629 BIMANUAL PLAY BY THE WORK OF 3724 02:21:01,629 --> 02:21:03,664 Dr. GORDON AND NOT FOR 3725 02:21:03,664 --> 02:21:06,467 GETTING, THE ROLE OF PARENT 3726 02:21:06,467 --> 02:21:07,067 EDUCATION. 3727 02:21:07,067 --> 02:21:08,702 IN THE JUST-RIGHT CHALLENGE 3728 02:21:08,702 --> 02:21:11,205 SENSORY EXPOSURES, MIRRORED TO 3729 02:21:11,205 --> 02:21:12,740 PARALLEL SEQUENCES AND INFANT 3730 02:21:12,740 --> 02:21:14,041 LEARNING PRINCIPLES, ALL OF 3731 02:21:14,041 --> 02:21:15,709 THESE WERE BASED ON THE WORK OF 3732 02:21:15,709 --> 02:21:20,848 THE INCREDIBLE LATE Dr. 3733 02:21:20,848 --> 02:21:21,348 CASE-SMITH. 3734 02:21:21,348 --> 02:21:23,751 IN ADDITION, PARENT FEEDBACK 3735 02:21:23,751 --> 02:21:26,420 FROM EARLY PILOT STUDIES, PLAYED 3736 02:21:26,420 --> 02:21:28,823 A CRITICAL ROLE IN THE DESIGN OF 3737 02:21:28,823 --> 02:21:30,357 THE APPLE STUDY. 3738 02:21:30,357 --> 02:21:32,393 WHILE THIS WAS A RANDOMIZED 3739 02:21:32,393 --> 02:21:34,528 CONTROL TRIAL, WE ENDED UP 3740 02:21:34,528 --> 02:21:36,664 HAVING A WAIT LESS CONTROL 3741 02:21:36,664 --> 02:21:37,097 GROUP. 3742 02:21:37,097 --> 02:21:37,498 WHY? 3743 02:21:37,498 --> 02:21:38,532 BECAUSE PARENTS TOLD US THEY 3744 02:21:38,532 --> 02:21:39,567 WERE NOT WILLING TO PARTICIPATE 3745 02:21:39,567 --> 02:21:42,403 IN A STUDY WITH THEIR BABY WHO 3746 02:21:42,403 --> 02:21:43,537 HAD CEREBRAL PALSY UNLESS THEIR 3747 02:21:43,537 --> 02:21:47,141 CHILD HAD AN INTERVENTION. 3748 02:21:47,141 --> 02:21:48,909 WE HAD A FOUR-WEEK LONG 3749 02:21:48,909 --> 02:21:50,010 INTERVENTION THAT WAS ONLY AN 3750 02:21:50,010 --> 02:21:53,314 HOUR A DAY COMBINED OF ALL PLAY 3751 02:21:53,314 --> 02:21:53,681 ACTIVITIES. 3752 02:21:53,681 --> 02:21:55,783 AND THAT IS BECAUSE PARENTS TOLD 3753 02:21:55,783 --> 02:21:57,184 US THEY DIDN'T WANT TO SPEND 3754 02:21:57,184 --> 02:21:58,719 MORE THAN AN HOUR A DAY. 3755 02:21:58,719 --> 02:22:00,955 THIS HAD TO FIT IN THEIR NORMAL 3756 02:22:00,955 --> 02:22:03,490 ROUTINE AND NOT BE DISRUPTIVE TO 3757 02:22:03,490 --> 02:22:05,726 THEIR WORK-LIFE BALANCE AND IT 3758 02:22:05,726 --> 02:22:08,295 JUST COULDN'T FEEL LIKE TOO MUCH 3759 02:22:08,295 --> 02:22:08,996 EXTRA WORK. 3760 02:22:08,996 --> 02:22:13,667 IN ADDITION, TO INCLUDING BABIES 3761 02:22:13,667 --> 02:22:15,569 SIX TO 24 MONTHS OF AGE, WE THEN 3762 02:22:15,569 --> 02:22:18,172 FOCUSED ON PRIMARY OUTCOMES. 3763 02:22:18,172 --> 02:22:20,074 WHICH WANTED MECHANISTICALLY 3764 02:22:20,074 --> 02:22:21,008 BASED OUTCOMES. 3765 02:22:21,008 --> 02:22:23,444 THOSE THAT WE CAN GET FROM EEG 3766 02:22:23,444 --> 02:22:27,081 SUCH AS CORTICAL SEW MAT OWE 3767 02:22:27,081 --> 02:22:29,216 SENSORY FUNCTION AND SMOOTHNESS 3768 02:22:29,216 --> 02:22:31,886 OF REACH, BUT WE ALSO NEEDED TO 3769 02:22:31,886 --> 02:22:33,420 LOOK AT OUTCOMES THAT MATTERED 3770 02:22:33,420 --> 02:22:37,258 TO PARENTS AND THOSE ARE 3771 02:22:37,258 --> 02:22:47,868 PERFORMANCE OUT BECAUSE THEY TOS 3772 02:22:48,202 --> 02:22:49,203 WE KNOW BETTER WHAT THEY'RE 3773 02:22:49,203 --> 02:22:50,671 DOING A LOT A HOME THAN YOU CAN 3774 02:22:50,671 --> 02:22:52,273 AT A SINGLE TEST VISIT. 3775 02:22:52,273 --> 02:22:54,475 SO WE INCLUDED THE MOTOR LOCK 3776 02:22:54,475 --> 02:22:57,945 AND IN ADDITION TO ALL THESE 3777 02:22:57,945 --> 02:23:00,447 MEASURES OF CAPACITY AND 3778 02:23:00,447 --> 02:23:02,216 PERFORMANCE, AND 3779 02:23:02,216 --> 02:23:02,917 MECHANISTICALLY -BASED MEASURES, 3780 02:23:02,917 --> 02:23:06,554 WE NEEDED TO LOOK AT SAFETY 3781 02:23:06,554 --> 02:23:06,987 MEASURES. 3782 02:23:06,987 --> 02:23:09,056 FOR THE LESS EFFECTED EXTREMELY 3783 02:23:09,056 --> 02:23:10,558 THAT WAS GOING TO BE TESTED, 3784 02:23:10,558 --> 02:23:14,428 THAT WAS GOING TO BE RETRAINED 3785 02:23:14,428 --> 02:23:16,297 WE KNEW WE NEEDED TO BE CAREFUL 3786 02:23:16,297 --> 02:23:19,900 BASED ON PRIOR RESEARCH. 3787 02:23:19,900 --> 02:23:21,902 SO IN ADDITION TO SAFETY, WE 3788 02:23:21,902 --> 02:23:24,238 THEN HAD TO LOOK AT OUR 3789 02:23:24,238 --> 02:23:25,439 INTERVENTIONS AND WE WANTED TO 3790 02:23:25,439 --> 02:23:28,409 MAKE SURE THAT WE WERE 3791 02:23:28,409 --> 02:23:31,779 DELIVERING IT WITH RIGGER AND 3792 02:23:31,779 --> 02:23:32,846 FIDELITY WHICH REQUIRES THE 3793 02:23:32,846 --> 02:23:34,515 PARENT TO WRITE DOWN OR THROUGH 3794 02:23:34,515 --> 02:23:37,284 AN APP, TO TELL US HOW OFTEN AND 3795 02:23:37,284 --> 02:23:39,386 HOW WELL THEY'RE DOING THIS. 3796 02:23:39,386 --> 02:23:40,921 WELL, OUR PARENTS TOLD US WE 3797 02:23:40,921 --> 02:23:43,190 JUST CAN'T TAKE THE EXTRA TIME 3798 02:23:43,190 --> 02:23:46,660 EVERY SINGLE DAY TO LOG DAILY 3799 02:23:46,660 --> 02:23:48,896 USE, EVEN IN AN HOUR. 3800 02:23:48,896 --> 02:23:49,997 IT'S JUST TOO MUCH. 3801 02:23:49,997 --> 02:23:51,765 WE'RE GOING TO FORGET. 3802 02:23:51,765 --> 02:23:54,969 SO WE USED FIT BITS, WHICH IN 3803 02:23:54,969 --> 02:23:57,338 ADDITION TO LETTING US KNOW WHEN 3804 02:23:57,338 --> 02:23:58,672 THE MITTS WERE USED, WERE ABLE 3805 02:23:58,672 --> 02:24:02,509 TO QUANTIFY IT AND WE ALSO AT 3806 02:24:02,509 --> 02:24:04,912 EACH VISIT, VIDEOTAPED AND 3807 02:24:04,912 --> 02:24:06,780 MONITORED THE PARENTS ON 3808 02:24:06,780 --> 02:24:08,182 FIDELITY SHEETS TO MAKE SURE 3809 02:24:08,182 --> 02:24:09,883 THAT THEY WERE DOING THE 3810 02:24:09,883 --> 02:24:14,822 INTERCEPTINTERVENTION CORRECTLY. 3811 02:24:14,822 --> 02:24:16,223 WHAT HAPPENED IN APPLES? 3812 02:24:16,223 --> 02:24:17,157 IT'S FINISHED RIGHT? 3813 02:24:17,157 --> 02:24:19,893 THAT WAS THE FIRST FIVE YEARS OF 3814 02:24:19,893 --> 02:24:20,127 APPLES. 3815 02:24:20,127 --> 02:24:21,295 WE WERE ABLE TO ACHIEVE MORE 3816 02:24:21,295 --> 02:24:22,630 THAN WE THOUGHT. 3817 02:24:22,630 --> 02:24:25,099 FIRST, WE HAD INCREDIBLE 3818 02:24:25,099 --> 02:24:26,567 DIVERSITY AND CAPACITY IN OUR 3819 02:24:26,567 --> 02:24:28,702 FAMILIES THAT WERE ENROLLED. 3820 02:24:28,702 --> 02:24:33,340 WHILE OHIO, ESPECIALLY ALCOHOL , 3821 02:24:33,340 --> 02:24:35,909 MAY NO NOT SEEM LIKE THE MOST 3822 02:24:35,909 --> 02:24:37,544 DIVERSE PLACE, WE WERE ABLE TO 3823 02:24:37,544 --> 02:24:39,179 ENHANCE DIVERSITY OF RECRUITMENT 3824 02:24:39,179 --> 02:24:42,416 IN OUR POPULATION AND YOU CAN 3825 02:24:42,416 --> 02:24:44,918 SEE THIS, WHILE OUR POPULATION 3826 02:24:44,918 --> 02:24:46,787 WAS 26% BLACK AND AFRICAN 3827 02:24:46,787 --> 02:24:48,455 AMERICAN, THE LOCAL POPULATION 3828 02:24:48,455 --> 02:24:52,626 WAS ACTUALLY LESS THAN 16%. 3829 02:24:52,626 --> 02:24:56,030 WE ALSO MADE SURE THAT OUR 3830 02:24:56,030 --> 02:24:57,931 FAMILIES HAD AN EDUCATIONAL 3831 02:24:57,931 --> 02:25:00,868 LEVEL THAT WAS REPRESENTATIVE OF 3832 02:25:00,868 --> 02:25:05,406 MANY DIFFERENT PEOPLE AND YOU 3833 02:25:05,406 --> 02:25:07,041 CAN SEE 50% OF THE POPULATION 3834 02:25:07,041 --> 02:25:08,709 HAD A HIGH SCHOOL DIPLOMA OR 3835 02:25:08,709 --> 02:25:11,512 LESS AND YET, WITH ALL OF THESE 3836 02:25:11,512 --> 02:25:14,381 THINGS, INCLUDING A MEDIAN BMSS 3837 02:25:14,381 --> 02:25:16,583 THAT IS SOCIALLY ECONOMIC LEVEL 3838 02:25:16,583 --> 02:25:20,621 THAT WAS IN THE LOW MIDDLE TO 3839 02:25:20,621 --> 02:25:22,289 POVERTY LEVEL, DESPITE ALL OF 3840 02:25:22,289 --> 02:25:24,625 THESE THINGS, THESE AMAZING 3841 02:25:24,625 --> 02:25:27,094 PARENTS WERE ABLE TO CARRY OUT 3842 02:25:27,094 --> 02:25:28,395 THE INTRA SELECTION WITH UTTER 3843 02:25:28,395 --> 02:25:30,998 COMPLIANCE AND YOU CAN SEE THAT 3844 02:25:30,998 --> 02:25:32,032 THE SCENE WHERE IT WAS 48 HOURS 3845 02:25:32,032 --> 02:25:35,402 A WEEK, WHEN WE ONLY REQUESTED A 3846 02:25:35,402 --> 02:25:37,971 MINIMUM OF 30 AND THEIR FIDEL 3847 02:25:37,971 --> 02:25:40,140 TEE TO THE INTERVENTION THAT WE 3848 02:25:40,140 --> 02:25:43,777 MEASURED EXCEEDED 95% 3849 02:25:43,777 --> 02:25:44,378 CORRECTNESS. 3850 02:25:44,378 --> 02:25:46,180 SO, WE KNEW WE COULD DO THIS 3851 02:25:46,180 --> 02:25:49,616 WITH A DIVERSE POPULATION AND 3852 02:25:49,616 --> 02:25:51,251 THEY WERE FULLY CAPABLE AND 3853 02:25:51,251 --> 02:25:52,786 WONDERFUL ABOUT IT. 3854 02:25:52,786 --> 02:25:54,354 SO, WHAT WERE THE OTHER 3855 02:25:54,354 --> 02:25:56,890 OUTCOMES? 3856 02:25:56,890 --> 02:25:57,858 WELL, GREAT. 3857 02:25:57,858 --> 02:26:01,161 ON EEG WE KNEW THAT THERE WAS A 3858 02:26:01,161 --> 02:26:06,667 GRAY AMP ATTI AMPLITUDE TO TOUCE 3859 02:26:06,667 --> 02:26:08,802 KNEW IT INCREASED COMPARED TO 3860 02:26:08,802 --> 02:26:09,670 OUR CONTROLS. 3861 02:26:09,670 --> 02:26:14,274 SAME THING WITH KINEMATICS AND 3862 02:26:14,274 --> 02:26:16,844 SAME THING WITH THE BAILEY UNI 3863 02:26:16,844 --> 02:26:17,644 MANUAL ITEMS. 3864 02:26:17,644 --> 02:26:19,747 WE HAD OUR MECHANISTIC AND OUR 3865 02:26:19,747 --> 02:26:21,482 EFFICACY MEASURES BUT WE ALSO 3866 02:26:21,482 --> 02:26:24,184 SAW THIS TREMENDOUS INCREASE IN 3867 02:26:24,184 --> 02:26:26,053 THE INFANT MOTOR ACTIVITY LOG 3868 02:26:26,053 --> 02:26:28,555 WHICH IS THE PARENT PERFORMANCE 3869 02:26:28,555 --> 02:26:29,123 MEASURES. 3870 02:26:29,123 --> 02:26:30,791 AND FINALLY, WE SHOW THAT THIS 3871 02:26:30,791 --> 02:26:33,527 WAS A SAFE INTERVENTION AND WE 3872 02:26:33,527 --> 02:26:36,964 WERE NOT ADVERSELY EFFECTING THE 3873 02:26:36,964 --> 02:26:38,832 CONSTRAINED EXTREMITY AND THAT 3874 02:26:38,832 --> 02:26:41,001 WE WERE NOT HINDERING GROSS 3875 02:26:41,001 --> 02:26:43,704 MOTOR DEVELOPMENT OR BUY MANUAL 3876 02:26:43,704 --> 02:26:45,506 DEVELOPMENT THROUGH OUR 3877 02:26:45,506 --> 02:26:45,839 INTERVENTION. 3878 02:26:45,839 --> 02:26:47,407 NOW SOME OF THE NEW AND MORE 3879 02:26:47,407 --> 02:26:48,942 EXCITING RESULTS. 3880 02:26:48,942 --> 02:26:52,012 WE ACTUALLY SHOWED THAT WE WERE 3881 02:26:52,012 --> 02:26:54,715 ABLE TO CHANGE THE NEURAL 3882 02:26:54,715 --> 02:26:56,784 PATTERN GENERATORS THE BRAIN IN 3883 02:26:56,784 --> 02:26:58,585 RESPONSE TO TOUCH AND MEANING 3884 02:26:58,585 --> 02:27:01,655 THESE BABIES ACTUALLY WERE ABLE 3885 02:27:01,655 --> 02:27:03,524 TO REWIRE THEIR SENSE OF TOUCH 3886 02:27:03,524 --> 02:27:05,392 IN THEIR MORE EFFECTED 3887 02:27:05,392 --> 02:27:05,659 EXTREMITY. 3888 02:27:05,659 --> 02:27:08,695 THE WAY WE DID THIS IS THROUGH 3889 02:27:08,695 --> 02:27:09,563 EEG. 3890 02:27:09,563 --> 02:27:15,936 WE DEVELOPED MAPS IN OVER 150 3891 02:27:15,936 --> 02:27:18,005 TERM, 150 TIP BEINGLY DEVELOPING 3892 02:27:18,005 --> 02:27:21,108 INFANTS WHO WERE MATCHED THROUGH 3893 02:27:21,108 --> 02:27:23,644 CORRECTED AGE AT TESTING AND 3894 02:27:23,644 --> 02:27:26,246 GESTATIONAL AGE AT BIRTH TO OUR 3895 02:27:26,246 --> 02:27:27,014 CP CHILDREN. 3896 02:27:27,014 --> 02:27:30,184 WHAT WE DID, WE CREATED TYPICAL 3897 02:27:30,184 --> 02:27:33,387 MAPS OF NEURO PATTERN GENERATORS 3898 02:27:33,387 --> 02:27:35,389 AND RESPONSE TO TOUCH. 3899 02:27:35,389 --> 02:27:37,624 WE THEN LOOKED AT OUR BABIES 3900 02:27:37,624 --> 02:27:40,494 WITH CP IN OUR INTERVENTION 3901 02:27:40,494 --> 02:27:42,629 GROUP AND OUR WAIT LIST 3902 02:27:42,629 --> 02:27:43,397 CONTROLLED GROUP. 3903 02:27:43,397 --> 02:27:45,465 WHAT WE WERE ABLE TO SHOW IS 3904 02:27:45,465 --> 02:27:48,635 THAT THESE MAPS WERE ACTUALLY 3905 02:27:48,635 --> 02:27:50,437 FITTING MORE, THESE BABIES WERE 3906 02:27:50,437 --> 02:27:52,439 SPENDING MORE TIMES IN NEURAL 3907 02:27:52,439 --> 02:27:54,842 PATTERN GENERATORS MAPS THAT 3908 02:27:54,842 --> 02:27:58,011 CORRESPONDED MORE TO THE 3909 02:27:58,011 --> 02:27:59,379 TYPICALLY DEVELOPING CHILDREN. 3910 02:27:59,379 --> 02:28:01,348 THE WAY THIS IS SHOWN HERE IS ON 3911 02:28:01,348 --> 02:28:02,783 THE LOWER PANEL. 3912 02:28:02,783 --> 02:28:07,688 IN THE INTERVENTION GROUP, THE 3913 02:28:07,688 --> 02:28:09,957 TOP LINE REPRESENTS BEFORE THE 3914 02:28:09,957 --> 02:28:14,895 INTERVENTION AND THE BOTTOM 3915 02:28:14,895 --> 02:28:15,262 AFTER. 3916 02:28:15,262 --> 02:28:17,264 THE FURTHER AWAY WE ARE FROM THE 3917 02:28:17,264 --> 02:28:18,699 BOTTOM OF THE FURTHER AWAY WE 3918 02:28:18,699 --> 02:28:23,003 ARE FROM A TYPICAL RESPONSE 3919 02:28:23,003 --> 02:28:24,304 THESE MAPS WERE SPENDING LESS 3920 02:28:24,304 --> 02:28:28,375 TIME AND WE DON'T FIT AS WELL 3921 02:28:28,375 --> 02:28:30,677 WITH THAT MAP OF NEURO PATTERN 3922 02:28:30,677 --> 02:28:34,248 GENERATORS TO TOUCH AND THERE'S 3923 02:28:34,248 --> 02:28:35,082 A BIG CHANGE. 3924 02:28:35,082 --> 02:28:37,918 IT CAN BE QUANTIFIED THROUGH 3925 02:28:37,918 --> 02:28:42,456 STATISTICS AND IT'S SIGNIFICANT. 3926 02:28:42,456 --> 02:28:43,523 THE WIT LESS CONTROL GROUP DID 3927 02:28:43,523 --> 02:28:45,192 NOT HAVE IT HAPPEN. 3928 02:28:45,192 --> 02:28:47,160 IT WAS WORSENING IN THE MONTH 3929 02:28:47,160 --> 02:28:48,962 DIFFERENCE BETWEEN THE TWO. 3930 02:28:48,962 --> 02:28:50,264 SO, IT WAS REALLY COOL. 3931 02:28:50,264 --> 02:28:53,100 SO WHAT WAS THE AFFECT OF 3932 02:28:53,100 --> 02:28:54,268 CHANGING THAT IMMEDIATELY AFTER 3933 02:28:54,268 --> 02:28:56,270 THE INTERVENTION? 3934 02:28:56,270 --> 02:28:58,605 FOR THE FIRST TIME, WE'VE BEEN 3935 02:28:58,605 --> 02:29:00,974 ABLE TO SHOW, TO FOLLOW THREE 3936 02:29:00,974 --> 02:29:02,643 YEARS OF UP TO THREE YEARS OF 3937 02:29:02,643 --> 02:29:07,447 AGE THESE BABIES AND R. S REMEME 3938 02:29:07,447 --> 02:29:09,349 STARTED AT SIX MONTHS AND SOME 3939 02:29:09,349 --> 02:29:10,784 STARTED AT 24 MONTHS BUT WE 3940 02:29:10,784 --> 02:29:12,819 FOLLOWED ALL OF THEM TO THREE. 3941 02:29:12,819 --> 02:29:15,088 I'M SO EXCITED BECAUSE FOR THE 3942 02:29:15,088 --> 02:29:16,790 FIRST TIME WE WERE ABLE TO LOOK 3943 02:29:16,790 --> 02:29:19,259 AT TRAJECTORIES OF DEVELOPMENTS. 3944 02:29:19,259 --> 02:29:21,662 THANK YOU CAN SEE IN YELLOW, 3945 02:29:21,662 --> 02:29:25,432 THIS COHORT OF TYPICALLY 3946 02:29:25,432 --> 02:29:27,901 DEVELOPING MATCHED CHILDREN FOR 3947 02:29:27,901 --> 02:29:28,502 GESTATIONAL AGE AND CORRECTED 3948 02:29:28,502 --> 02:29:29,569 AGE AT TESTING TIME. 3949 02:29:29,569 --> 02:29:31,605 NO SURPRISE, THIS IS THE 3950 02:29:31,605 --> 02:29:34,107 TRAJECTORY OF THIS MILESTONE 3951 02:29:34,107 --> 02:29:36,476 ACQUISITION IN ONE EXTREMITY 3952 02:29:36,476 --> 02:29:41,648 WHICH WAS THEIR DOMINANT ONE, IT 3953 02:29:41,648 --> 02:29:44,584 WAS RANDOMLY A SIGNED. 3954 02:29:44,584 --> 02:29:47,321 NO SURPRISE, IT'S LINEAR ACROSS 3955 02:29:47,321 --> 02:29:47,521 TIME. 3956 02:29:47,521 --> 02:29:49,823 WE HAVE THE NUMBER OF MONTHS 3957 02:29:49,823 --> 02:29:52,292 CORRECTED AGE AND HERE WE HAVE 3958 02:29:52,292 --> 02:29:55,762 THE NUMBER OF DEVELOPMENTAL 3959 02:29:55,762 --> 02:29:56,029 SKILLS. 3960 02:29:56,029 --> 02:29:59,066 WHEN WE LOOK A LOT PATIENTS WHO 3961 02:29:59,066 --> 02:30:01,001 HAVE CEREBRAL PALSY AND WHO DID 3962 02:30:01,001 --> 02:30:02,869 NOT RECEIVE APPLES, SO THIS WAS 3963 02:30:02,869 --> 02:30:03,937 OFTEN THE FIRST POINT OF 3964 02:30:03,937 --> 02:30:05,238 TESTING, OR SOME OF THE POINTS 3965 02:30:05,238 --> 02:30:07,040 IN THE WAIT LIST GROUP. 3966 02:30:07,040 --> 02:30:08,975 THIS IS ALSO NO SURPRISE. 3967 02:30:08,975 --> 02:30:11,678 THERE'S A TRAJECTORY THAT GOES 3968 02:30:11,678 --> 02:30:12,879 FURTHER AND FURTHER AWAY FROM 3969 02:30:12,879 --> 02:30:15,349 THE TYPICALLY DEVELOPING 3970 02:30:15,349 --> 02:30:15,615 CHILDREN. 3971 02:30:15,615 --> 02:30:17,617 MANY INCREDIBLE RESEARCHERS SOME 3972 02:30:17,617 --> 02:30:20,253 OF THEM AT THIS WORKSHOP HAVE 3973 02:30:20,253 --> 02:30:22,022 ALREADY SHOWN THAT THE 3974 02:30:22,022 --> 02:30:24,157 TRAJECTORY OF UNI MANUAL SKILLS 3975 02:30:24,157 --> 02:30:28,862 IN A MORE EFFECTED EXTREMITY 3976 02:30:28,862 --> 02:30:29,663 WILL DIVERGE OVER TIME AND THEN 3977 02:30:29,663 --> 02:30:33,934 WE HAVE THE BABIES WITH APPLES. 3978 02:30:33,934 --> 02:30:35,602 AND OVER TIME THAT REWIRING OF 3979 02:30:35,602 --> 02:30:37,337 THE BRAIN AND THE SKILLS THAT 3980 02:30:37,337 --> 02:30:41,675 THEY ACQUIRED EARLIER, ACTUALLY 3981 02:30:41,675 --> 02:30:44,177 STARTED TO GET THEIR TRAJECTORY 3982 02:30:44,177 --> 02:30:48,482 CLOSER TO THAT OF TYPICALLY 3983 02:30:48,482 --> 02:30:49,149 VEMMING CHILDREN. 3984 02:30:49,149 --> 02:30:51,885 SO IT'S NOT PERFECT, I KNOW. 3985 02:30:51,885 --> 02:30:53,153 THIS CAN BE QUANTIFIED IN 3986 02:30:53,153 --> 02:30:53,854 ANOTHER WAY. 3987 02:30:53,854 --> 02:30:55,889 IF WE LOCK AT THE NEW MILESTONES 3988 02:30:55,889 --> 02:30:59,426 ACQUIRED PER MONTH, TYPICALLY 3989 02:30:59,426 --> 02:31:01,194 DEVELOPING CHILDREN ACQUIRE 3990 02:31:01,194 --> 02:31:02,929 BETWEEN .5 AND 1. 3991 02:31:02,929 --> 02:31:04,598 WHEREAS, OVER THE COURSE OF 3992 02:31:04,598 --> 02:31:07,334 THREE YEARS, WHEREAS OUR BABIES 3993 02:31:07,334 --> 02:31:09,736 WITH CP AND APPLES, THIS IS 3994 02:31:09,736 --> 02:31:15,475 CLASSIFIED ACCORDING TO TMSCS 3995 02:31:15,475 --> 02:31:19,312 AND SOME OF THEM MORE. 3996 02:31:19,312 --> 02:31:21,581 YOU THINK BUT THEIR SCORES WON'T 3997 02:31:21,581 --> 02:31:23,683 HIGHER AND THEY STARTED OFF 3998 02:31:23,683 --> 02:31:23,884 LOWER. 3999 02:31:23,884 --> 02:31:25,452 WE KNOW OUR INTERVENTION IS 4000 02:31:25,452 --> 02:31:27,254 WORKING AND IT'S WORKING IN THE 4001 02:31:27,254 --> 02:31:34,327 LONG-TERM AND IT PROBABLY JUST 4002 02:31:34,327 --> 02:31:38,565 KEEPS IN SUMMARY IT'S POSSIBLE 4003 02:31:38,565 --> 02:31:41,368 TO DESIGN AN INTERCEPTIONS THAT 4004 02:31:41,368 --> 02:31:45,739 IS SCIENTIFICALLY SOUND, 4005 02:31:45,739 --> 02:31:46,907 MECHANISTICALLY BASED THAT IS 4006 02:31:46,907 --> 02:31:49,142 SAFE, EFFECTIVE, GENERALIZABLE 4007 02:31:49,142 --> 02:31:53,146 THAT HAS PARENT EMPOWERMENT AT 4008 02:31:53,146 --> 02:31:54,748 ITS CORE AND, HOWEVER, WITH ALL 4009 02:31:54,748 --> 02:31:57,717 OF THIS, WE ALSO SAW THAT THERE 4010 02:31:57,717 --> 02:31:59,619 WERE SO MANY MORE OPPORTUNITIES 4011 02:31:59,619 --> 02:32:00,420 FOR IMPROVEMENT. 4012 02:32:00,420 --> 02:32:02,089 WE NEEDED TO MAKE THIS BETTER. 4013 02:32:02,089 --> 02:32:05,392 TO GET THOSE TRAJECTORIES TO 4014 02:32:05,392 --> 02:32:06,093 FULLY CLOSE. 4015 02:32:06,093 --> 02:32:11,264 BUT THE FIRST THING IS, WE CAN'T 4016 02:32:11,264 --> 02:32:11,465 WAIT. 4017 02:32:11,465 --> 02:32:12,265 WE HAVE TO DELIVER SOMETHING 4018 02:32:12,265 --> 02:32:13,066 THAT WORKS. 4019 02:32:13,066 --> 02:32:20,707 THE FIRST THING WAS DISSEMINATE 4020 02:32:20,707 --> 02:32:23,143 AND THE WAY WE DO IS IS BY 4021 02:32:23,143 --> 02:32:25,946 LEVERAGING STAKEHOLDER FEEDBACK. 4022 02:32:25,946 --> 02:32:29,015 FROM LARGE SYSTEMATIC REVIEWS OF 4023 02:32:29,015 --> 02:32:30,317 INTERVENTIONS THAT WE CAN 4024 02:32:30,317 --> 02:32:31,084 CONDUCTED, THANKS TO THE 4025 02:32:31,084 --> 02:32:33,286 CEREBRAL PALSY FOUNDATION. 4026 02:32:33,286 --> 02:32:37,190 WE SAW ACROSS MANY DOMAINS THAT 4027 02:32:37,190 --> 02:32:38,225 INTERVENTIONS THAT OUR PARENT 4028 02:32:38,225 --> 02:32:40,127 DELIVERED ARE THOSE THAT ARE 4029 02:32:40,127 --> 02:32:42,496 STAKEHOLDERS WANTED. 4030 02:32:42,496 --> 02:32:44,764 ABOVE THOSE BY THERAPISTS AND 4031 02:32:44,764 --> 02:32:46,099 CERTAINLY MORE THAN THOSE THAT 4032 02:32:46,099 --> 02:32:48,134 ARE SURGICAL OR MEDICAL. 4033 02:32:48,134 --> 02:32:50,837 WE ALSO DID A NATIONAL SURVEY OF 4034 02:32:50,837 --> 02:32:52,606 PARENTS AND INDIVIDUALS WITH 4035 02:32:52,606 --> 02:32:53,273 DISABILITIES. 4036 02:32:53,273 --> 02:32:55,609 AND THEY SAID AFTER EVEN MILD 4037 02:32:55,609 --> 02:33:00,447 PERINATAL INSULTS, THEY VALUE 4038 02:33:00,447 --> 02:33:02,449 DYADIC FAMILY INTERACTIONS HAS A 4039 02:33:02,449 --> 02:33:05,385 TOP PRIORITY IN OUTCOMES AND IN 4040 02:33:05,385 --> 02:33:05,919 DESIGN. 4041 02:33:05,919 --> 02:33:07,487 AND THEN WHEN WE DID STUDY 4042 02:33:07,487 --> 02:33:09,789 PARTICIPANT FEEDBACK, WE SAW, 4043 02:33:09,789 --> 02:33:11,091 AGAIN, THAT PARENTS WANTED 4044 02:33:11,091 --> 02:33:12,893 OUTCOMES THAT MATTERED IN THEIR 4045 02:33:12,893 --> 02:33:13,693 DAILY LIVES. 4046 02:33:13,693 --> 02:33:17,831 AND PROVIDERS WHO VALUE THEM AS 4047 02:33:17,831 --> 02:33:18,632 TEAM MEMBERS. 4048 02:33:18,632 --> 02:33:20,500 SO BEFORE IMPROVING APPLES, WITH 4049 02:33:20,500 --> 02:33:22,869 ALL OF THIS, WE KNEW THAT FIRST, 4050 02:33:22,869 --> 02:33:25,705 WE NEEDED TO BUILD CAPACITY TO 4051 02:33:25,705 --> 02:33:28,942 GO YOUNGER AND GET MORE FEEDBACK 4052 02:33:28,942 --> 02:33:31,077 AND FOR THAT WE NEEDED TO BUILD 4053 02:33:31,077 --> 02:33:32,646 EARLY DETECTION CAPACITY IN 4054 02:33:32,646 --> 02:33:34,281 HIGH-RISK INFANT FOLLOW-UP 4055 02:33:34,281 --> 02:33:36,149 SETTINGS AND IN THE COMMUNITY. 4056 02:33:36,149 --> 02:33:37,984 SO THESE INTERVENTIONS COULD 4057 02:33:37,984 --> 02:33:40,921 START EARLIER AND IN AN INFANT'S 4058 02:33:40,921 --> 02:33:41,288 LIFE. 4059 02:33:41,288 --> 02:33:42,889 WE NEEDED TO CREATE A PIPELINE 4060 02:33:42,889 --> 02:33:46,326 FOR RAPID KNOWLEDGE TRANSLATION 4061 02:33:46,326 --> 02:33:48,094 AND DISSEMINATION TO PARENTS AND 4062 02:33:48,094 --> 02:33:49,496 PROVIDERS SO IF AN INTERVENTION 4063 02:33:49,496 --> 02:33:51,665 IS SAFE AND EFFECTIVE, WE CAN 4064 02:33:51,665 --> 02:33:53,200 THEN START EARLIER AND THEN 4065 02:33:53,200 --> 02:33:55,068 START WORKING ON IMPROVEMENTS AT 4066 02:33:55,068 --> 02:33:57,571 THE SAME TIME AS WE'RE 4067 02:33:57,571 --> 02:33:58,471 DISSEMINATING THE EARLIER 4068 02:33:58,471 --> 02:33:59,806 VERSION OF IT. 4069 02:33:59,806 --> 02:34:02,042 SO HOW DID WE DO THIS? 4070 02:34:02,042 --> 02:34:04,377 HOW DID WE MEET THESE NEEDS? 4071 02:34:04,377 --> 02:34:07,547 WE PARTNERED WITH THE CEREBRAL 4072 02:34:07,547 --> 02:34:08,481 PALSY FOUNDATION AND THEY'VE 4073 02:34:08,481 --> 02:34:10,717 BEEN INCREDIBLE BECAUSE WE'VE 4074 02:34:10,717 --> 02:34:13,553 BEEN ABLE TO, ACROSS A LARGE 4075 02:34:13,553 --> 02:34:15,555 NETWORK OF HIGH-RISK INFANT 4076 02:34:15,555 --> 02:34:19,059 FOLLOW-UP PROGRAMS IN THE UNITED 4077 02:34:19,059 --> 02:34:20,961 STATES, DECREASE THE AGE AT 4078 02:34:20,961 --> 02:34:24,864 EARLY DETECTION, BELOW THE AGE, 4079 02:34:24,864 --> 02:34:26,533 BELOW 12 MONTHS CORRECT TO DATE. 4080 02:34:26,533 --> 02:34:28,768 THIS, DESPITE THE IMPACT OF 4081 02:34:28,768 --> 02:34:31,338 COVID, IT STABILIZED AND I CAN 4082 02:34:31,338 --> 02:34:34,808 TELL YOU 2022 NUMBERS ARE RIGHT 4083 02:34:34,808 --> 02:34:39,579 AROUND NOW THAT 11-MONTH MARK. 4084 02:34:39,579 --> 02:34:43,450 AND THEY ALSO HELPED US CORRECT 4085 02:34:43,450 --> 02:34:45,185 A CONFERENCE AND SUMMIT THAT 4086 02:34:45,185 --> 02:34:46,886 FOCUSES ON JUST ON DETECTION 4087 02:34:46,886 --> 02:34:51,725 ANDER SEDEANDINTERVENTION BUT I. 4088 02:34:51,725 --> 02:34:55,362 THESE ARE SOME THE TOOLS WE USE, 4089 02:34:55,362 --> 02:34:59,866 IMPLEMENTATION SCIENCE, NETWORKS 4090 02:34:59,866 --> 02:35:00,333 EDUCATIONAL TOOLS AND 4091 02:35:00,333 --> 02:35:02,168 IMPLEMENTATION TOOLS THAT ARE 4092 02:35:02,168 --> 02:35:03,903 BEING DISSEMINATED FOR SEVERAL 4093 02:35:03,903 --> 02:35:06,206 RESULTS, FIRST, IN ADDITION TO 4094 02:35:06,206 --> 02:35:08,341 DECREASING THE AGE AS CP 4095 02:35:08,341 --> 02:35:10,176 DIAGNOSIS TO LESS THAN 12 4096 02:35:10,176 --> 02:35:12,245 MONTHS, WE ALSO MADE SURE THAT 4097 02:35:12,245 --> 02:35:13,480 OVER 4,000 PROVIDERS WERE 4098 02:35:13,480 --> 02:35:17,751 TRAINED IN EARLY DETECTION 4099 02:35:17,751 --> 02:35:18,084 INTERVENTION. 4100 02:35:18,084 --> 02:35:19,753 MORE THAN TWO DOES TRAINERS NOW 4101 02:35:19,753 --> 02:35:22,355 ARE CONTINUOUSLY INCREASING THE 4102 02:35:22,355 --> 02:35:24,491 CAPACITY AND THE SYSTEM. 4103 02:35:24,491 --> 02:35:27,060 WE'RE ALSO THROUGH THE CPF, 4104 02:35:27,060 --> 02:35:28,695 THEY'RE PARTNERING WITH OTHER 4105 02:35:28,695 --> 02:35:30,697 FOUNDATIONS IN THEIR EFFORTS AND 4106 02:35:30,697 --> 02:35:33,466 THEY'RE HELPING THE UCP OR THE 4107 02:35:33,466 --> 02:35:37,904 CPA, ACHIEVE THEIR OWN GOALS. 4108 02:35:37,904 --> 02:35:42,575 AND THEN WE HAVE A CONSENSUS 4109 02:35:42,575 --> 02:35:43,877 STATEMENT THAT WE PUBLISHED. 4110 02:35:43,877 --> 02:35:46,446 IF WORE GOING TO DESIGN EARLIER 4111 02:35:46,446 --> 02:35:48,314 INTERVENTIONS WE NEED TO START 4112 02:35:48,314 --> 02:35:51,151 WITH A DESIGNATION THAT EVERYONE 4113 02:35:51,151 --> 02:35:53,887 CAN AGREE ON FOR HIGH-RISK OF 4114 02:35:53,887 --> 02:35:54,254 CEREBRAL PALSY. 4115 02:35:54,254 --> 02:35:56,956 SO WE ENGAGE LEADERS ACROSS ALL 4116 02:35:56,956 --> 02:35:58,858 OF NORTH AMERICA AND WE HAVE 4117 02:35:58,858 --> 02:36:00,427 THIS ENORMOUS CONSENSUS 4118 02:36:00,427 --> 02:36:02,462 STATEMENT THAT WE PUBLISHED ON 4119 02:36:02,462 --> 02:36:03,663 WHAT THAT CONSTITUTES. 4120 02:36:03,663 --> 02:36:06,866 SO WE CAN START INTERVENTIONS 4121 02:36:06,866 --> 02:36:07,333 EARLIER. 4122 02:36:07,333 --> 02:36:09,102 AND SOME OF THESE PEOPLE ARE 4123 02:36:09,102 --> 02:36:11,671 ACTUALLY AT THIS WORKSHOP. 4124 02:36:11,671 --> 02:36:14,708 HEY, STACEY. 4125 02:36:14,708 --> 02:36:16,876 THE FOURTH RESULT IS THAT WE 4126 02:36:16,876 --> 02:36:19,245 WERE ABLE TO TRAIN WITHIN ONE 4127 02:36:19,245 --> 02:36:23,550 YEAR OVER 100 COMMUNITY 4128 02:36:23,550 --> 02:36:24,451 PROVIDERS IN APPLES 4129 02:36:24,451 --> 02:36:25,485 ADMINISTRATION AND TOOLS. 4130 02:36:25,485 --> 02:36:30,256 WITHIN ONE YEAR OF PUBLICATION. 4131 02:36:30,256 --> 02:36:32,392 AND SO, WHILE IT'S NOT PERFECT, 4132 02:36:32,392 --> 02:36:33,560 APPLES, AT LEAST IT'S GETTING 4133 02:36:33,560 --> 02:36:35,095 OUT THERE AND PEOPLE ARE GETTING 4134 02:36:35,095 --> 02:36:37,564 TRAINED IN IT. 4135 02:36:37,564 --> 02:36:39,699 AND THIS ALLOWS US TO NOW MOVE 4136 02:36:39,699 --> 02:36:42,302 TO THE COMPETING RENEWAL WHICH 4137 02:36:42,302 --> 02:36:47,240 YEAH, THANK YOU NIH GOT FUNDED 4138 02:36:47,240 --> 02:36:49,609 AND IT'S IMPROVING ON APPLE'S 4139 02:36:49,609 --> 02:36:52,679 TELLING AND WE KNOW THAT 15 4140 02:36:52,679 --> 02:36:54,914 MONTHS SEEMS TO BE THAT THE 4141 02:36:54,914 --> 02:36:56,716 TIPPING POINT IN WHEN THE 4142 02:36:56,716 --> 02:36:58,985 INTERVENTION WORKS BEST, WE CAN 4143 02:36:58,985 --> 02:37:02,155 START BELOW THAT AND TELEHEALTH 4144 02:37:02,155 --> 02:37:04,424 WHICH HAS SHOWN TO BE FEASIBLE 4145 02:37:04,424 --> 02:37:07,193 AND EFFECTIVE AS A DELIVERY TOOL 4146 02:37:07,193 --> 02:37:09,929 HAS SOME STANDARDIZATION ISSUES 4147 02:37:09,929 --> 02:37:11,531 AND HAS SOME OTHER ISSUES THAT 4148 02:37:11,531 --> 02:37:13,500 WE CAN ADDRESS BUT WE STUDIED 4149 02:37:13,500 --> 02:37:15,201 THAT AND IT COULD PROVIDE A 4150 02:37:15,201 --> 02:37:17,237 VIABLE ALTERNATIVE IN TREATING 4151 02:37:17,237 --> 02:37:19,372 AN INFANT WITH CP. 4152 02:37:19,372 --> 02:37:22,442 AND WE ALSO KNOW THAT PARENT 4153 02:37:22,442 --> 02:37:24,444 INTERVENTIONS COULD INCREASE THE 4154 02:37:24,444 --> 02:37:27,013 EFFECT OF INFANT INTERVENTIONS 4155 02:37:27,013 --> 02:37:29,315 SO THIS TIME THE GOAL OF APPLES 4156 02:37:29,315 --> 02:37:31,317 TELE IS NOT JUST TO IMPROVE HAND 4157 02:37:31,317 --> 02:37:34,387 AND ARM USE IN BABIES, 12 MONTHS 4158 02:37:34,387 --> 02:37:37,991 AND UNDER, WITH CP OR HIGH-RISK 4159 02:37:37,991 --> 02:37:40,760 FOR CP, VIA TELEHEALTH OR 4160 02:37:40,760 --> 02:37:41,227 IN-PERSON. 4161 02:37:41,227 --> 02:37:42,996 IT'S ALSO TO EMPOWER PARENTS 4162 02:37:42,996 --> 02:37:44,297 THROUGH KNOWLEDGE, PARENTING 4163 02:37:44,297 --> 02:37:45,665 SKILLS AND PRACTICE. 4164 02:37:45,665 --> 02:37:48,635 AND TO TARGET OUR INTERVENTIONS 4165 02:37:48,635 --> 02:37:52,205 TO DETERMINE WHICH DYADS MIGHT 4166 02:37:52,205 --> 02:37:53,606 BENEFIT FROM PARTICIPATING 4167 02:37:53,606 --> 02:37:56,676 INTERVENTIONS BEFORE THEY HAVE 4168 02:37:56,676 --> 02:37:59,045 INTERVENTIONS, MOTOR 4169 02:37:59,045 --> 02:38:01,481 INTERVENTIONS AND SO IN CLOSING, 4170 02:38:01,481 --> 02:38:03,316 WE HAVE APPLES TELE WHICH IS A 4171 02:38:03,316 --> 02:38:05,084 DESIGN NOW THAT INCORPORATES 4172 02:38:05,084 --> 02:38:11,691 EVERYTHING I'VE TOLD YOU ABOUT. 4173 02:38:11,691 --> 02:38:13,059 267 PARTICIPANTS ACROSS FOUR OF 4174 02:38:13,059 --> 02:38:16,729 THE NETWORK SITES OF EARLY 4175 02:38:16,729 --> 02:38:17,197 DETECTION. 4176 02:38:17,197 --> 02:38:18,765 OUR OUTCOMES INCLUDE MANY 4177 02:38:18,765 --> 02:38:20,166 PARENTING OUTCOMES, THE ONES 4178 02:38:20,166 --> 02:38:23,469 THAT THEY WANTED ABOUT DYADS AND 4179 02:38:23,469 --> 02:38:25,138 PARENTS AND ALSO PERFORMANCE IN 4180 02:38:25,138 --> 02:38:29,375 THE HOME AND SOME STANDARD ONES. 4181 02:38:29,375 --> 02:38:30,476 THERE'S THREE GROUPS. 4182 02:38:30,476 --> 02:38:32,979 ONE GETS BUSINESS AS USUAL BUT 4183 02:38:32,979 --> 02:38:34,514 REMEMBER, THEY WANT THAT 4184 02:38:34,514 --> 02:38:35,281 INTERVENTION EITHER. 4185 02:38:35,281 --> 02:38:37,517 SO THEY GET TO CHOSE AFTER THAT 4186 02:38:37,517 --> 02:38:38,918 WHATEVER INTERVENTION THAT THEY 4187 02:38:38,918 --> 02:38:39,586 WANT. 4188 02:38:39,586 --> 02:38:41,387 PARENTING OR MOTOR. 4189 02:38:41,387 --> 02:38:43,122 AND THERE'S ONE THAT GETS THE 4190 02:38:43,122 --> 02:38:44,691 APPLE TELE INTERVENTION FIRST 4191 02:38:44,691 --> 02:38:46,593 AND THE LAST THAT GETS THE 4192 02:38:46,593 --> 02:38:49,996 PARENTING INTERVENTION FIRST. 4193 02:38:49,996 --> 02:38:52,499 THERE'S ALSO COST EFFECTIVENESS 4194 02:38:52,499 --> 02:38:57,403 AND AN SIL AR STUDY AND THE 4195 02:38:57,403 --> 02:38:59,172 REPOSITIVITY FOR ALL AI ANALYSIS 4196 02:38:59,172 --> 02:39:01,074 AND WORE DOING WELL. 4197 02:39:01,074 --> 02:39:02,642 12 PARTICIPANTS WERE RECRUITED 4198 02:39:02,642 --> 02:39:04,010 IN THE LAST TWO MONTHS AND NOW 4199 02:39:04,010 --> 02:39:06,012 THAT WE'VE HAD THIS OUTPOURING 4200 02:39:06,012 --> 02:39:09,482 FROM A COUNTRY WIDE FEEDBACK 4201 02:39:09,482 --> 02:39:12,185 FROM PARENTS, WE ARE ACTUALLY 4202 02:39:12,185 --> 02:39:16,155 HAVE 10 THIS COMING MONTH. 4203 02:39:16,155 --> 02:39:18,291 SO WHAT IS NEXT TO DEVELOP 4204 02:39:18,291 --> 02:39:21,895 APPLES NEXT-GEN THANKS TO WORK 4205 02:39:21,895 --> 02:39:23,930 ABOUT NIH FROM NIH FUNDED 4206 02:39:23,930 --> 02:39:27,267 RESEARCHERS AT THIS WORK SOLVE 4207 02:39:27,267 --> 02:39:29,469 AND WE ALSO NEED TO EXPAND 4208 02:39:29,469 --> 02:39:31,004 KNOWLEDGE TRANSLATION AND 4209 02:39:31,004 --> 02:39:32,739 DISSEMINATION AS WE GO WITH OUR 4210 02:39:32,739 --> 02:39:36,643 FOUNDATION PARTNERS. 4211 02:39:36,643 --> 02:39:38,845 WE HAVE LEVERAGED ALL OF THIS TO 4212 02:39:38,845 --> 02:39:40,980 BECOME THE NEURO DEVELOPMENTAL 4213 02:39:40,980 --> 02:39:42,782 CORE FOR THREE LARGE MULTI 4214 02:39:42,782 --> 02:39:45,118 CENTERED TRIALS, ALLOWING 4215 02:39:45,118 --> 02:39:47,720 EXPANSION OF CP RESEARCH THROUGH 4216 02:39:47,720 --> 02:39:58,264 OTHER TYPES OF TRIALS AND WE ARE 4217 02:40:01,100 --> 02:40:03,970 USING SOCIAL MEDIA TO DELIVER A 4218 02:40:03,970 --> 02:40:05,905 MOTOR INTERVENTION WITH THE CPF 4219 02:40:05,905 --> 02:40:07,006 AND UNICEF. 4220 02:40:07,006 --> 02:40:10,543 SO MY KEY POINT, IN ADDITION, TO 4221 02:40:10,543 --> 02:40:13,112 THANKING SO MANY PEOPLE THAT ARE 4222 02:40:13,112 --> 02:40:14,514 RIGHT THERE, IS THAT IF WE'RE 4223 02:40:14,514 --> 02:40:16,783 GOING TO FOCUS ON CP RESEARCH 4224 02:40:16,783 --> 02:40:19,819 AND INFANCY, WE CAN FOCUS 4225 02:40:19,819 --> 02:40:21,354 ESPECIALLY ON SCIENTIFICALLY 4226 02:40:21,354 --> 02:40:27,093 SOUND RESEARCH AND THAT BOTHERS 4227 02:40:27,093 --> 02:40:28,261 TO BE SAFE CONNECT TIVE 4228 02:40:28,261 --> 02:40:30,630 IMPLEMENTABLE AND IMPLEMENTED. 4229 02:40:30,630 --> 02:40:32,932 I HOPE YOU WILL SEE THE VALUE OF 4230 02:40:32,932 --> 02:40:34,334 THIS AND THANK YOU SO MUCH FOR 4231 02:40:34,334 --> 02:40:38,338 YOUR TIME AND ATTENTION. 4232 02:40:38,338 --> 02:40:43,076 >> HELLO MY NAME IS BERNADETTE 4233 02:40:43,076 --> 02:40:43,443 GILLICK. 4234 02:40:43,443 --> 02:40:44,777 I'M FROM THE UNIVERSITY OF 4235 02:40:44,777 --> 02:40:45,678 WISCONSIN MADISON. 4236 02:40:45,678 --> 02:40:47,413 AND I'M LOOKING FORWARD TO 4237 02:40:47,413 --> 02:40:49,515 SPEAKING TO YOU TODAY ON THIS 4238 02:40:49,515 --> 02:40:51,050 STRATEGIC PLAN PRIORITY AREA ONE 4239 02:40:51,050 --> 02:40:53,286 BASIC AND TRANSLATIONAL RESEARCH 4240 02:40:53,286 --> 02:40:54,821 ABOUT CORTICAL PLASTICITY AND 4241 02:40:54,821 --> 02:40:57,690 HOW THAT RELATES TO RECOVERY 4242 02:40:57,690 --> 02:40:58,391 FROM NEWER LOGIC INSULT IN 4243 02:40:58,391 --> 02:41:00,193 ADULTS AND PEDIATRIC 4244 02:41:00,193 --> 02:41:00,493 POPULATIONS. 4245 02:41:00,493 --> 02:41:01,694 THANK YOU VERY MUCH FOR THE 4246 02:41:01,694 --> 02:41:02,495 INVITATION TO PRESENT. 4247 02:41:02,495 --> 02:41:04,030 THANK YOU TO ALL WHO ARE 4248 02:41:04,030 --> 02:41:05,298 ORGANIZING THIS EVENT AND I LOOK 4249 02:41:05,298 --> 02:41:07,900 FORWARD TO THE OTHER TALKS AS 4250 02:41:07,900 --> 02:41:08,468 WELL. 4251 02:41:08,468 --> 02:41:10,370 SO, RELATE TO GO THE PRIORITY 4252 02:41:10,370 --> 02:41:12,972 AREAS AND RECOMMENDATIONS OF THE 4253 02:41:12,972 --> 02:41:13,940 2017 STRATEGIC PLAN, THERE'S A 4254 02:41:13,940 --> 02:41:16,042 LOT OF OVERLAP WITH CORTICAL 4255 02:41:16,042 --> 02:41:17,343 PLASTICITY AND I CHOSE TO 4256 02:41:17,343 --> 02:41:19,112 HIGHLIGHT HERE A FEW OF THE 4257 02:41:19,112 --> 02:41:20,913 DIFFERENT AREAS THAT THIS TALK 4258 02:41:20,913 --> 02:41:23,349 WILL ENCOMPASS AND HAVE BASIC 4259 02:41:23,349 --> 02:41:24,450 THREADS THROUGH INCLUDING 4260 02:41:24,450 --> 02:41:25,818 TRANSLATIONAL RESEARCH, BASIC 4261 02:41:25,818 --> 02:41:27,286 RESEARCH AND CLINICAL RESEARCH 4262 02:41:27,286 --> 02:41:28,921 AND IN UNDERSTANDING AND 4263 02:41:28,921 --> 02:41:31,024 UTILIZING NEURO PLASTICITY AND 4264 02:41:31,024 --> 02:41:33,426 ALSO CONSIDERING THE LIFESPAN 4265 02:41:33,426 --> 02:41:43,770 AND ENHANCING TREATMENT OPTIONS. 4266 02:41:43,770 --> 02:41:45,438 THE ADAPTIVE CAPACITY OF THE 4267 02:41:45,438 --> 02:41:48,141 CENTRAL NERVOUS SYSTEM AND THAT 4268 02:41:48,141 --> 02:41:49,442 NEURONS CAN ALTER THEIR 4269 02:41:49,442 --> 02:41:51,444 STRUCTURE AND THEIR FUNCTION SO 4270 02:41:51,444 --> 02:41:53,513 THROUGH INTERNAL SIGNALS AND 4271 02:41:53,513 --> 02:41:55,348 EXTERNAL SIGNALS, THAT STRUCTURE 4272 02:41:55,348 --> 02:41:57,450 AND FUNCTION CAN BE CHANGED. 4273 02:41:57,450 --> 02:41:59,819 AND NEURO PLASTICITY IS THE 4274 02:41:59,819 --> 02:42:01,721 MECHANISM IN THE BRAIN IN CODES 4275 02:42:01,721 --> 02:42:03,022 EXPERIENCES AND LEAPS NEW 4276 02:42:03,022 --> 02:42:09,896 BEHAVILEARNS NEW BEHAVIORAND DAT 4277 02:42:09,896 --> 02:42:10,997 BEHAVIOR OR DEVELOP AND CONTINUE 4278 02:42:10,997 --> 02:42:14,834 TO DEVELOP IN THE FACE OF THIS 4279 02:42:14,834 --> 02:42:15,468 DAMAGE. 4280 02:42:15,468 --> 02:42:16,836 SO, WHAT HAPPENS OVER THE 4281 02:42:16,836 --> 02:42:19,705 LIFETIME AND THE LIFESPAN OF AN 4282 02:42:19,705 --> 02:42:21,307 INDIVIDUAL IN TERMS OF PLASTIC 4283 02:42:21,307 --> 02:42:23,076 CAPACITY WITHIN THE CORTEX AND 4284 02:42:23,076 --> 02:42:24,944 HOW THEY MAY ACTUALLY RECOVER 4285 02:42:24,944 --> 02:42:28,147 FROM A NEWER LOGIC INSULT. 4286 02:42:28,147 --> 02:42:29,949 SO THERE'S A COUPLE WAYS TO 4287 02:42:29,949 --> 02:42:32,452 DEFINE THE POTENTIAL OF NEURO 4288 02:42:32,452 --> 02:42:34,053 PLASTICITY TO BE ADAPTIVE IN 4289 02:42:34,053 --> 02:42:37,056 THAT WE CAN LEARN NEW SKILLS OR 4290 02:42:37,056 --> 02:42:39,425 RESTORE LOST FUNCTION AND ALSO 4291 02:42:39,425 --> 02:42:40,359 MALL ADAPTIVE IN TERMS OF THE 4292 02:42:40,359 --> 02:42:41,694 PLASTICITY OF THE NERVOUS SYSTEM 4293 02:42:41,694 --> 02:42:43,730 LEADING TO A DISRUPTION IN 4294 02:42:43,730 --> 02:42:44,097 FUNCTION. 4295 02:42:44,097 --> 02:42:46,232 SO AS I SAID, NOT ALL PLASTICITY 4296 02:42:46,232 --> 02:42:47,066 IS GOOD. 4297 02:42:47,066 --> 02:42:52,205 SO FOCAL DYSTONIA, LIMB PAIN, 4298 02:42:52,205 --> 02:42:54,240 SEIZURES, THESE ARE ALL 4299 02:42:54,240 --> 02:42:55,541 POTENTIALLY MALL ADAPTIVE 4300 02:42:55,541 --> 02:42:58,377 COMPONENTS OF PLASTICITY THAT 4301 02:42:58,377 --> 02:42:59,545 CAN OCCUR. 4302 02:42:59,545 --> 02:43:01,481 SO WE ALSO WANT TO LOOK AT HOW 4303 02:43:01,481 --> 02:43:03,382 WE MEASURE NEURO PLASTICITY AND 4304 02:43:03,382 --> 02:43:04,016 THE TIME SCALES. 4305 02:43:04,016 --> 02:43:06,519 HOW EASY IS IT TO DO? 4306 02:43:06,519 --> 02:43:08,788 SO ON SHORT TERM SCALE IN MILLI 4307 02:43:08,788 --> 02:43:12,625 SECONDS OR SECONDS, YOU ARE 4308 02:43:12,625 --> 02:43:14,160 PROBABLY VES CAL OR NEURO 4309 02:43:14,160 --> 02:43:16,028 TRANSMITTER RELEASE CAN BE 4310 02:43:16,028 --> 02:43:17,563 MEASURED AND ON THE SHORT TIME 4311 02:43:17,563 --> 02:43:18,831 SPAIN IT'S A CHALLENGING THING 4312 02:43:18,831 --> 02:43:20,399 TO DO ESPECIALLY IN HUMANS AND 4313 02:43:20,399 --> 02:43:22,068 THE LONGER TERM IN TERMS OF 4314 02:43:22,068 --> 02:43:23,269 MINUTES OR HOURS, YOU CAN 4315 02:43:23,269 --> 02:43:25,037 MEASURE THE INCREASE DENSITY OF 4316 02:43:25,037 --> 02:43:27,974 RECEPTORS AND THE POST SYNAPTIC 4317 02:43:27,974 --> 02:43:29,575 MEMBRANE CHARGING IN HUMANS TO 4318 02:43:29,575 --> 02:43:31,744 DO OR BEHAVIORAL PLASTICITY. 4319 02:43:31,744 --> 02:43:33,346 IN TERMS OF WHAT WE SEE IN WEEKS 4320 02:43:33,346 --> 02:43:35,081 AND MONTHS AND YEARS AND 4321 02:43:35,081 --> 02:43:37,150 REHABILITATIONS AND THAT'S MORE 4322 02:43:37,150 --> 02:43:38,718 FEASIBLE AND MAY BE AN INDICATOR 4323 02:43:38,718 --> 02:43:39,619 OF THE PROCESSES THAT WE TALKED 4324 02:43:39,619 --> 02:43:41,020 ABOUT THAT ARE MORE CHALLENGES 4325 02:43:41,020 --> 02:43:44,657 AGAIN IN MEASURING IN HUMANS. 4326 02:43:44,657 --> 02:43:46,692 PEOPLE OFTEN DISCUSS AND I OFTEN 4327 02:43:46,692 --> 02:43:49,428 TALK ABOUT IS A PEDIATRIC BRAIN 4328 02:43:49,428 --> 02:43:51,063 MORE PLASTIC THAN AN ADULT 4329 02:43:51,063 --> 02:43:51,998 BRAIN? 4330 02:43:51,998 --> 02:43:54,367 AND I TYPICALLY GO BACK TO THE 4331 02:43:54,367 --> 02:43:57,804 CONNARD PRINCIPLE OF A 4332 02:43:57,804 --> 02:43:58,738 NEUROLOGIST WHOSE STATEMENT IN 4333 02:43:58,738 --> 02:44:03,009 GOOD RESEARCH IN THE 1930s AND 4334 02:44:03,009 --> 02:44:06,479 40s IN INFANT MONKEYS SHOWED 4335 02:44:06,479 --> 02:44:07,813 THERE'S A NEGATIVE LINEAR 4336 02:44:07,813 --> 02:44:08,848 RELATIONSHIP BETWEEN THE AGE AND 4337 02:44:08,848 --> 02:44:10,049 FUNCTIONAL OUTCOME. 4338 02:44:10,049 --> 02:44:11,951 THIS QUOTE IS SHARED AND THE 4339 02:44:11,951 --> 02:44:12,785 YOUNGER THE LEASH AN ORGANISM 4340 02:44:12,785 --> 02:44:16,589 THE BETTER THE OUTCOME. 4341 02:44:16,589 --> 02:44:17,890 HOWEVER, SHE ALSO SHOWED THAT 4342 02:44:17,890 --> 02:44:21,594 ADULT PRIMATES WITH STROKE SORRY 4343 02:44:21,594 --> 02:44:23,362 BRAIN LESIONS CAN ALSO EXHIBIT 4344 02:44:23,362 --> 02:44:24,063 SIGNIFICANT SPARING AND RECOVERY 4345 02:44:24,063 --> 02:44:25,631 OF FUNCTION, ESPECIALLY IN THE 4346 02:44:25,631 --> 02:44:29,936 LESIONS ARE IN STAGES AND NOT 4347 02:44:29,936 --> 02:44:30,837 ALL AT ONCE. 4348 02:44:30,837 --> 02:44:33,239 THE JURY IS OUT IN TERMS OF 4349 02:44:33,239 --> 02:44:34,807 PEDIATRIC BRAIN MORE PLASTIC 4350 02:44:34,807 --> 02:44:37,376 THAN IN AN ADULT BRAIN, IT 4351 02:44:37,376 --> 02:44:39,078 DEPENDS ON THE INJURY AND WHEN 4352 02:44:39,078 --> 02:44:39,912 AND WHEN IT OCCURRED. 4353 02:44:39,912 --> 02:44:43,216 THIS IS AN ARTICLE ON SA 4354 02:44:43,216 --> 02:44:44,817 REMEMBER RAL PLASTICITY FOR THE 4355 02:44:44,817 --> 02:44:46,219 DEVELOPING BRAIN FROM ISMAIL AND 4356 02:44:46,219 --> 02:44:49,055 IT GIVES A REALLY INTERESTING 4357 02:44:49,055 --> 02:44:50,223 DEPICTION OF THE DIFFERENT 4358 02:44:50,223 --> 02:44:51,991 FACETS OR PATTERNS OF NEURO 4359 02:44:51,991 --> 02:44:53,759 PLASTICITY AND SO I MENTIONED 4360 02:44:53,759 --> 02:44:55,394 ADAPTIVE AND MALL ADAPTIVE BUT 4361 02:44:55,394 --> 02:44:57,496 IF YOU BREAK IT DOWN NO 4362 02:44:57,496 --> 02:44:59,799 DEVELOPMENTAL ADAPTIVE, 4363 02:44:59,799 --> 02:45:01,534 REACTIVE, EXCESSIVE 4364 02:45:01,534 --> 02:45:03,202 DESTABILIZEING AND THE 4365 02:45:03,202 --> 02:45:04,737 VULNERABILITY OF THE CENTRAL 4366 02:45:04,737 --> 02:45:05,571 NERVOUS SYSTEM YOU CAN SEE THE 4367 02:45:05,571 --> 02:45:07,840 DIFFERENT ASPECTS OF HOW NEURO 4368 02:45:07,840 --> 02:45:09,475 PLASTICITY CAN BE DEFINED. 4369 02:45:09,475 --> 02:45:11,978 HOW IS IT TYPICAL OR ATYPICAL AS 4370 02:45:11,978 --> 02:45:13,613 STATED HERE NORMAL OR IMPAIRED 4371 02:45:13,613 --> 02:45:15,281 AND HOW IS IT DEPENDING UPON THE 4372 02:45:15,281 --> 02:45:18,217 INJURY THAT MIGHT HAVE OCCURRED? 4373 02:45:18,217 --> 02:45:20,486 IN THIS ARTICLE, THEY GO ON TO 4374 02:45:20,486 --> 02:45:22,455 TALK ABOUT THE TARGETS THAT HAVE 4375 02:45:22,455 --> 02:45:25,191 BEEN SHOWN TO CONTRIBUTE MOTOR 4376 02:45:25,191 --> 02:45:25,625 SENSORY IMPAIR. 4377 02:45:25,625 --> 02:45:27,360 AND PATIENTS WITH CEREBRAL 4378 02:45:27,360 --> 02:45:27,560 PALSY. 4379 02:45:27,560 --> 02:45:29,095 AND SO WHEN WE LOOK AT ALL OF 4380 02:45:29,095 --> 02:45:31,397 THESE DIFFERENT TARGETS, 4381 02:45:31,397 --> 02:45:32,965 INCLUDING THE CORTICAL SPINAL 4382 02:45:32,965 --> 02:45:34,867 TRACT, AND OTHER TRACKS, IS IT 4383 02:45:34,867 --> 02:45:37,436 REALLY TIME TO ADOPT A MULTI 4384 02:45:37,436 --> 02:45:39,572 MODAL BEHAVIORAL PHARMACOLOGICAL 4385 02:45:39,572 --> 02:45:44,176 OR STIMULATION-BASED 4386 02:45:44,176 --> 02:45:45,478 MULTI-TARGETED NEURO MODULAR 4387 02:45:45,478 --> 02:45:48,147 APPROACH TO BEHAVIORAL OUTCOMES 4388 02:45:48,147 --> 02:45:49,682 AGAIN WITH THE CORTICAL 4389 02:45:49,682 --> 02:45:49,982 PLASTICITY. 4390 02:45:49,982 --> 02:45:51,617 I'LL TAKE A MODEL OF ADULT 4391 02:45:51,617 --> 02:45:54,186 STROKE WHERE WE HAVE ISCHEMIA 4392 02:45:54,186 --> 02:45:54,587 AND STROKE. 4393 02:45:54,587 --> 02:45:57,390 YOU CAN SEE HOW THERE ARE 4394 02:45:57,390 --> 02:45:59,191 VARIATIONS IN TERMS OF HOW THE 4395 02:45:59,191 --> 02:46:00,726 STROKE MIGHT HAVE IMPACTED 4396 02:46:00,726 --> 02:46:03,329 INDIVIDUALS WHO ARE CHILDREN OR 4397 02:46:03,329 --> 02:46:03,562 ADULTS. 4398 02:46:03,562 --> 02:46:06,198 IF WE TAKE THAT MODEL AND ADULTS 4399 02:46:06,198 --> 02:46:08,734 AND APPLY IT TO EARLY INJURY IN 4400 02:46:08,734 --> 02:46:10,269 STROKE AND CEREBRAL PALSY, WE'RE 4401 02:46:10,269 --> 02:46:13,873 WORKING WITH A MUCH DIFFERENT 4402 02:46:13,873 --> 02:46:15,408 TYPE OF ENVIRONMENT. 4403 02:46:15,408 --> 02:46:16,909 SO, EARLY INJURY TO THE BRAIN OR 4404 02:46:16,909 --> 02:46:18,110 STROKE IS A COMMON CAUSE OF 4405 02:46:18,110 --> 02:46:19,645 CEREBRAL PALSY. 4406 02:46:19,645 --> 02:46:20,513 AND CEREBRAL PALSY AS WE KNOW IS 4407 02:46:20,513 --> 02:46:22,281 THE MOST COMMON MOTOR DISABILITY 4408 02:46:22,281 --> 02:46:24,283 IN CHILDHOOD. 4409 02:46:24,283 --> 02:46:27,153 SO, THE TWO DIFFERENT MODELS, 4410 02:46:27,153 --> 02:46:28,387 ADULT STROKE AND PEDIATRIC 4411 02:46:28,387 --> 02:46:31,057 STROKE ARE THE STROKE PERINATAL 4412 02:46:31,057 --> 02:46:32,925 STROKE, HAVE DIFFERENT 4413 02:46:32,925 --> 02:46:34,226 APPROACHES IN TERMS OF HOW WE'RE 4414 02:46:34,226 --> 02:46:35,428 UNDERSTANDING CORTICAL 4415 02:46:35,428 --> 02:46:35,895 PLASTICITY. 4416 02:46:35,895 --> 02:46:36,963 AND WHEN WE LOOK AT THE 4417 02:46:36,963 --> 02:46:39,432 INCIDENTS OF STROKE IN ADULTS, 4418 02:46:39,432 --> 02:46:40,866 THE THOUSAND OUT OF 100,000 AND 4419 02:46:40,866 --> 02:46:42,535 THE CHANGE OVER THE LIFESPAN IF 4420 02:46:42,535 --> 02:46:44,804 YOU ACTUALLY DECREASE THE AGE, 4421 02:46:44,804 --> 02:46:47,340 FROM CHILDHOOD, ONE TO TWO IN 4422 02:46:47,340 --> 02:46:49,442 100,000, BUT ACTUALLY PERINATAL 4423 02:46:49,442 --> 02:46:51,477 STROKE 40 IN 100,000, YOU CAN 4424 02:46:51,477 --> 02:46:53,846 SEE THAT THE INCIDENTS ITSELF IS 4425 02:46:53,846 --> 02:46:55,781 INDICATIVE OF VARIATIONS IN 4426 02:46:55,781 --> 02:46:57,917 TERMS OF THE AGE OF THE 4427 02:46:57,917 --> 02:46:58,884 INDIVIDUALS AND ALSO WHERE THEY 4428 02:46:58,884 --> 02:47:01,487 ARE IN THEIR DEVELOPMENTAL 4429 02:47:01,487 --> 02:47:01,854 PHASES AS WELL. 4430 02:47:01,854 --> 02:47:03,255 HERE IS A PICTURE OF TWO 4431 02:47:03,255 --> 02:47:04,924 DIFFERENT MRIs, THE PERSON ON 4432 02:47:04,924 --> 02:47:06,425 THE LEFT IS A FEMALE, 4433 02:47:06,425 --> 02:47:07,693 35-YEAR-OLD FEMALE, DEVELOPING 4434 02:47:07,693 --> 02:47:11,931 AND THE PERSON ON THE RIGHT IS A 4435 02:47:11,931 --> 02:47:12,665 THREE--YEAR-OLD FEMALE 4436 02:47:12,665 --> 02:47:13,032 DEVELOPING. 4437 02:47:13,032 --> 02:47:15,001 YOU CAN SEE AS A NEURO SCIENTIST 4438 02:47:15,001 --> 02:47:16,669 OR RADIOLOGIST THAT THE 4439 02:47:16,669 --> 02:47:19,372 DIFFERENCE OF COURSE IN BRAIN 4440 02:47:19,372 --> 02:47:21,407 STRUCTURE AND AGE BUT YOU CAN 4441 02:47:21,407 --> 02:47:23,876 ALSO APPRECIATE THAT THESE TWO 4442 02:47:23,876 --> 02:47:25,444 DIFFERENT INDIVIDUALS ARE 4443 02:47:25,444 --> 02:47:26,979 DIFFERENT TIMEFRAMES IN THEIR 4444 02:47:26,979 --> 02:47:28,614 OWN DEVELOPMENT AND SO NOW HERE 4445 02:47:28,614 --> 02:47:31,717 IS TWO DIFFERENT MRI IMAGES. 4446 02:47:31,717 --> 02:47:33,152 ONE IS ADULT HAVING A STROKE ON 4447 02:47:33,152 --> 02:47:34,453 THE LEFT AND ANOTHER OF A CHILD 4448 02:47:34,453 --> 02:47:36,222 WITH A STROKE ON THE RIGHT AND 4449 02:47:36,222 --> 02:47:37,289 ALTHOUGH THEY'RE IN DIFFERENT 4450 02:47:37,289 --> 02:47:38,491 LOCATIONS AND DIFFERENT SIZES, 4451 02:47:38,491 --> 02:47:40,960 THE POINT BEING THAT THE STROKE 4452 02:47:40,960 --> 02:47:42,128 IS GOING TO INFLUENCE A BRAIN 4453 02:47:42,128 --> 02:47:43,796 THAT IS POTENTIALLY DEVELOPING 4454 02:47:43,796 --> 02:47:45,598 IN A MUCH DIFFERENT TIMEFRAME IN 4455 02:47:45,598 --> 02:47:46,165 THEIR LIFE. 4456 02:47:46,165 --> 02:47:47,700 AND I SHOWED THIS PICTURE 4457 02:47:47,700 --> 02:47:48,167 BEFORE. 4458 02:47:48,167 --> 02:47:49,468 THESE ARE 30 INDIVIDUALS WITH 4459 02:47:49,468 --> 02:47:50,870 WHOM WE WORKED IN OUR STUDIES 4460 02:47:50,870 --> 02:47:53,139 AND THIS IS FROM JESSICA CASSIDY 4461 02:47:53,139 --> 02:47:54,340 AND NER EARLY WORK WITH US. 4462 02:47:54,340 --> 02:47:55,708 IT SHOWS THE VARIATION IN 4463 02:47:55,708 --> 02:47:56,876 THOUSAND THAT STROKE CAN PRESENT 4464 02:47:56,876 --> 02:47:57,743 ITSELF TOO. 4465 02:47:57,743 --> 02:48:00,212 A VARIATION IN TERMS OF CORTICAL 4466 02:48:00,212 --> 02:48:04,016 PLASTICITY DEPENDING ON THE 4467 02:48:04,016 --> 02:48:05,818 LESION SIZE AND THE LESION 4468 02:48:05,818 --> 02:48:06,352 BURDEN OVER ALL. 4469 02:48:06,352 --> 02:48:08,888 THE POINT IS THAT IN ADULTS, WE 4470 02:48:08,888 --> 02:48:11,223 HAVE RECOVERY AND REORGANIZATION 4471 02:48:11,223 --> 02:48:12,658 AFTER EARLY STROKE. 4472 02:48:12,658 --> 02:48:14,360 AND AFTER STROKE AND THE ADULT 4473 02:48:14,360 --> 02:48:14,693 BRAIN. 4474 02:48:14,693 --> 02:48:16,462 BUT WHEN WE LOOK AT THE 4475 02:48:16,462 --> 02:48:17,530 PEDIATRIC BRAIN, WE HAVE 4476 02:48:17,530 --> 02:48:18,931 RECOVERY AND DEVELOPMENT SO IT 4477 02:48:18,931 --> 02:48:20,966 MAY NOT ACTUALLY SHALL 4478 02:48:20,966 --> 02:48:21,901 REORGANIZATIONS THAT WE'RE 4479 02:48:21,901 --> 02:48:23,469 TARGETING IT'S ACTUALLY 4480 02:48:23,469 --> 02:48:23,803 ORGANIZATION. 4481 02:48:23,803 --> 02:48:26,172 AND THE WAY THAT THE BRAIN IS 4482 02:48:26,172 --> 02:48:27,807 RECOVERING IS ACTUALLY 4483 02:48:27,807 --> 02:48:29,341 RECOVERING ALONG WITH 4484 02:48:29,341 --> 02:48:30,076 DEVELOPMENT AT THE SAME TIME. 4485 02:48:30,076 --> 02:48:31,944 MUCH DIFFERENT THAN A STROKE 4486 02:48:31,944 --> 02:48:34,180 IMPRESSED ON A MATURE, ADULT 4487 02:48:34,180 --> 02:48:35,581 NERVOUS SYSTEM. 4488 02:48:35,581 --> 02:48:37,817 THE INTERSECTION NOW OF NEURO 4489 02:48:37,817 --> 02:48:39,585 PLASTICITY IN NEURO MODULATION 4490 02:48:39,585 --> 02:48:40,719 ALLOWS US TO LEARN MORE. 4491 02:48:40,719 --> 02:48:42,154 THIS IS NEURO MODULATION IN 4492 02:48:42,154 --> 02:48:43,823 TERMS OF THE SPECTRUM OF THE 4493 02:48:43,823 --> 02:48:46,025 TECHNIQUES THAT WE HAVE OUT 4494 02:48:46,025 --> 02:48:47,560 THERE. 4495 02:48:47,560 --> 02:48:48,761 BEHAVIORAL NEURAL MODULATION AND 4496 02:48:48,761 --> 02:48:50,429 THE MOVEMENT THERAPY IS ONE OF 4497 02:48:50,429 --> 02:48:52,832 THOSE TYPES. 4498 02:48:52,832 --> 02:48:55,034 FARM CO LOGIC WITH THE CENTRAL 4499 02:48:55,034 --> 02:48:56,569 NERVOUS ACT MEDICATION THAT'S 4500 02:48:56,569 --> 02:48:57,603 INFLUENCE ESSENTIAL NERVOUS 4501 02:48:57,603 --> 02:48:59,605 SYSTEM AND ELECTRICAL NEURO 4502 02:48:59,605 --> 02:49:01,540 MODULATIONS SUCH AS TRANCE 4503 02:49:01,540 --> 02:49:02,341 CRANIAL DIRECTING CURRENT 4504 02:49:02,341 --> 02:49:03,876 STIMULATION OR SPINAL CORD 4505 02:49:03,876 --> 02:49:05,644 STIMULATION AND THE USE OF A 4506 02:49:05,644 --> 02:49:08,814 MAGNETIC FIELD LIKE REPETITIVE 4507 02:49:08,814 --> 02:49:14,220 TIM STIMULATION OR STEM CELL 4508 02:49:14,220 --> 02:49:17,256 TRANSPLANTS AND WHAT ARE THE 4509 02:49:17,256 --> 02:49:19,859 TYPES OF TECHNIQUES USED IN 4510 02:49:19,859 --> 02:49:21,894 ADULT AND PEDIATRICS THERE'S 4511 02:49:21,894 --> 02:49:22,962 THREE I WILL SHARE WITH YOU 4512 02:49:22,962 --> 02:49:23,329 TODAY. 4513 02:49:23,329 --> 02:49:25,231 ONE IS THE TRANCE CRANIAL DIRECT 4514 02:49:25,231 --> 02:49:26,599 CURRENT STIMULATION ON THE LEFT 4515 02:49:26,599 --> 02:49:30,035 AND THERE'S ANNAN OAT AND CATH 4516 02:49:30,035 --> 02:49:32,204 OAT AND WE'RE STIMULATING THE 4517 02:49:32,204 --> 02:49:35,741 BRAIN TO LONG-TERM INFLUENCE 4518 02:49:35,741 --> 02:49:38,744 FACILITATION INHIBITION. 4519 02:49:38,744 --> 02:49:41,847 TMS CAN DELIVER PULSES OF 4520 02:49:41,847 --> 02:49:43,749 ELECTRO MAGNETIC INDUCTION THAT 4521 02:49:43,749 --> 02:49:45,251 ACTUALLY ALLOW US TO UNDERSTAND 4522 02:49:45,251 --> 02:49:47,052 THE RESPONSE OF THE BRAIN TO 4523 02:49:47,052 --> 02:49:48,220 THOSE PULSES OR EVEN INFLUENCE 4524 02:49:48,220 --> 02:49:48,888 IT. 4525 02:49:48,888 --> 02:49:51,223 WE DO THOSE PULSES REPETITIVELY. 4526 02:49:51,223 --> 02:49:54,260 AND THEN THERE'S ALSO THE VIENNA 4527 02:49:54,260 --> 02:49:55,327 SYSTEM THAT I'LL TALK ABOUT IN 4528 02:49:55,327 --> 02:49:58,330 TERMS OF SPECIALIZING THE 4529 02:49:58,330 --> 02:50:00,599 ELECTRODES TO DELIVER ELECTRICAL 4530 02:50:00,599 --> 02:50:03,235 PULSES AND IT'S A BOTTOM-UP 4531 02:50:03,235 --> 02:50:05,004 APPROACH BECAUSE YOU STIMULATE 4532 02:50:05,004 --> 02:50:05,538 THE NERVE TO INFLUENCE THE 4533 02:50:05,538 --> 02:50:07,706 ACTIVITY OF THE CENTRAL NERVOUS 4534 02:50:07,706 --> 02:50:08,674 SYSTEM. 4535 02:50:08,674 --> 02:50:10,209 SO TRANCE CRANIAL MAGNETIC 4536 02:50:10,209 --> 02:50:11,377 STIMULATION THERE'S A STIMULATER 4537 02:50:11,377 --> 02:50:13,779 THAT I WILL IS ITS A RESPONSE 4538 02:50:13,779 --> 02:50:14,713 THAT THE RESPONSE I'M TALKING 4539 02:50:14,713 --> 02:50:17,049 ABOUT TODAY IS THE MOTOR EVOKED 4540 02:50:17,049 --> 02:50:18,217 RESPONSE AND WHEN WE LOOK AT 4541 02:50:18,217 --> 02:50:19,385 THIS THIS IS FROM A CHILD 4542 02:50:19,385 --> 02:50:20,886 WORKING WITH US IN OUR LAB. 4543 02:50:20,886 --> 02:50:25,424 WE CAN MEASURE THE AMPLITUDE AND 4544 02:50:25,424 --> 02:50:27,293 LOOK AT IT OVER TIME AND LOOK AT 4545 02:50:27,293 --> 02:50:28,861 IT BEFORE AND AFTER INTERVENTION 4546 02:50:28,861 --> 02:50:30,663 SO WE CAN REALLY ASSESS WHAT IS 4547 02:50:30,663 --> 02:50:32,731 HAPPENING WITH BRAIN PHYSIOLOGY. 4548 02:50:32,731 --> 02:50:34,300 AND BRINGING UP HERE SOME GREAT 4549 02:50:34,300 --> 02:50:37,870 WORK BY KATHY, AT THE UNIVERSITY 4550 02:50:37,870 --> 02:50:40,806 OF AUCKLAND IN TERMS OF USING 4551 02:50:40,806 --> 02:50:41,774 TMA IN ASSAULT STROKE. 4552 02:50:41,774 --> 02:50:44,009 IN TERMS OF AN ALGORITHM TO 4553 02:50:44,009 --> 02:50:45,778 PREDICT WHAT IS HAPPENING WITH 4554 02:50:45,778 --> 02:50:47,780 RECOVERY, YOU CAN SEE HERE 4555 02:50:47,780 --> 02:50:49,548 THERE'S MILD, MODERATE AND 4556 02:50:49,548 --> 02:50:51,584 SEVERE STROKE AND SHE USED TMS 4557 02:50:51,584 --> 02:50:53,219 TO UNDERSTAND HOW MUCH OR WHAT 4558 02:50:53,219 --> 02:50:56,155 IS THEIR PERCENTAGE OF MACHINE 4559 02:50:56,155 --> 02:51:05,030 MAXIMUM IMMEDIATED TO' LITT' ELT 4560 02:51:05,030 --> 02:51:06,432 AND IT GIVES YOU A WINDOW INTO 4561 02:51:06,432 --> 02:51:07,866 THE BRAIN TO THE EXCITE ABILITY 4562 02:51:07,866 --> 02:51:08,934 OF THE BRAIN AS IT RECOVERS 4563 02:51:08,934 --> 02:51:10,369 AFTER THE STROKE. 4564 02:51:10,369 --> 02:51:12,571 THAT ALGORITHM EXTENDS WHERE SHE 4565 02:51:12,571 --> 02:51:14,206 ACTUALLY INTEGRATES THAT MOTOR 4566 02:51:14,206 --> 02:51:15,908 VOLKSWAGEN POTENTIAL OUTCOME TO 4567 02:51:15,908 --> 02:51:17,776 UNDERSTAND WHAT THE POTENTIAL IS 4568 02:51:17,776 --> 02:51:19,211 FOR RECOVERY. 4569 02:51:19,211 --> 02:51:21,680 SO THEY'RE PREP 2 ALGORITHM 4570 02:51:21,680 --> 02:51:24,383 INCORPORATES THAT TMS IN MOTOR 4571 02:51:24,383 --> 02:51:25,284 EVOKED POTENTIAL. 4572 02:51:25,284 --> 02:51:27,453 THOSE PREDICTORS ALLOW A 4573 02:51:27,453 --> 02:51:29,622 DESCRIPTION OF THE OUTCOME. 4574 02:51:29,622 --> 02:51:30,789 SOMETHING DESCRIBE THEM TO USE 4575 02:51:30,789 --> 02:51:32,424 IN THE DISCUSSIONS WITH 4576 02:51:32,424 --> 02:51:32,691 PATIENTS. 4577 02:51:32,691 --> 02:51:34,360 AS WELL AS A FOCUS OF 4578 02:51:34,360 --> 02:51:35,661 REHABILITATION IN TERMS OF WHAT 4579 02:51:35,661 --> 02:51:37,329 SHOULD BE THE INTERVENTION AND 4580 02:51:37,329 --> 02:51:39,865 SHOULD THIS ACTUALLY BE GEARED 4581 02:51:39,865 --> 02:51:41,233 TOWARDS REHABILITATION 4582 02:51:41,233 --> 02:51:44,103 COMPENSATION AND OTHER 4583 02:51:44,103 --> 02:51:44,770 ACTIVITIES. 4584 02:51:44,770 --> 02:51:47,072 WE ALSO USE TMS WITH INFANTS AND 4585 02:51:47,072 --> 02:51:48,273 SOME OF THE WORK THAT I'M DOING 4586 02:51:48,273 --> 02:51:49,842 NOW TO MEASURE THE EXCITE 4587 02:51:49,842 --> 02:51:51,276 ABILITY AFTER EARLY BRAIN INJURY 4588 02:51:51,276 --> 02:51:53,145 SO WHETHER IT BE IN THE NICK YOU 4589 02:51:53,145 --> 02:51:56,615 ON THE LEFT OR THE LAB ON THE 4590 02:51:56,615 --> 02:51:58,384 RIGHT WE TRIED TO HAPPEN THE 4591 02:51:58,384 --> 02:52:01,120 BRAIN AS IT IS RECOVERING AFTER 4592 02:52:01,120 --> 02:52:02,221 EARLY PERINATAL INJURY. 4593 02:52:02,221 --> 02:52:04,189 THIS IS SOME OF THE WORK OF ALAN 4594 02:52:04,189 --> 02:52:08,060 SUITER A PPHD CANDIDATE LOOKING 4595 02:52:08,060 --> 02:52:10,062 AT SIMULATIONS OF THE ELECTRIC 4596 02:52:10,062 --> 02:52:12,097 FIELD INDUCES AND TRYING TO 4597 02:52:12,097 --> 02:52:13,265 UNDERSTAND WHAT WOULD OCCUR IF 4598 02:52:13,265 --> 02:52:16,101 WE STIMULATED AN INFANT BRAIN SO 4599 02:52:16,101 --> 02:52:19,238 ADULT BRAIN ON THE LEFT AND 4600 02:52:19,238 --> 02:52:21,140 FOUR-MONTH-OLD IN THE MIDDLE AND 4601 02:52:21,140 --> 02:52:22,675 24-MONTH-OLD SCAN OF AN INFANT 4602 02:52:22,675 --> 02:52:24,410 LOOKING AT WHAT WOULD BE THE 4603 02:52:24,410 --> 02:52:26,679 ELECTRIC CURRENT AND THE CURRENT 4604 02:52:26,679 --> 02:52:27,046 DENSITY. 4605 02:52:27,046 --> 02:52:28,714 WE CAN USE THIS TO ACTUALLY 4606 02:52:28,714 --> 02:52:29,882 UNDERSTAND HOW INFANT IS 4607 02:52:29,882 --> 02:52:31,150 DEVELOPING OVER TIME AND ON THE 4608 02:52:31,150 --> 02:52:32,718 LEFT IS THIS INFANT IS FOUR 4609 02:52:32,718 --> 02:52:34,253 MONTHS OLD CORRECTED AGE ON THE 4610 02:52:34,253 --> 02:52:35,554 RIGHT THEY'RE 14 MONTHS OLD. 4611 02:52:35,554 --> 02:52:38,157 AND WE CAN LOOK AT HOW THAT 4612 02:52:38,157 --> 02:52:39,124 MOTOR EVOKED POTENTIAL IS 4613 02:52:39,124 --> 02:52:40,526 CHANGING AND HOW THE SIGNAL IS 4614 02:52:40,526 --> 02:52:41,593 CHANGEING AND HOW THEY'RE 4615 02:52:41,593 --> 02:52:42,895 RESPONDING TO THE SIGNAL. 4616 02:52:42,895 --> 02:52:44,897 AS THEY DEVELOP AND HO AS WE 4617 02:52:44,897 --> 02:52:46,865 MEASURE BEHAVIORAL ASSESSMENTS 4618 02:52:46,865 --> 02:52:47,299 AS WELL. 4619 02:52:47,299 --> 02:52:49,535 SO WE HAVE A CURRENT STUDY 4620 02:52:49,535 --> 02:52:54,340 FUNDED BY A NIH RO1 BY THE NICHD 4621 02:52:54,340 --> 02:52:56,475 AND NINDS THAT LOOKS AT THE 4622 02:52:56,475 --> 02:52:58,877 RECOVERY OVER THE FIRST TWO 4623 02:52:58,877 --> 02:53:00,212 YEARS OF LIFE. 4624 02:53:00,212 --> 02:53:04,483 USING TMS AND MRI IN BEHAVIORAL 4625 02:53:04,483 --> 02:53:05,317 ASSESSMENTS WE UNDERSTAND AND 4626 02:53:05,317 --> 02:53:06,452 WORK WITH FAMILIES TO UNDERSTAND 4627 02:53:06,452 --> 02:53:08,287 HOW THAT CHILD'S RECOVERING AND 4628 02:53:08,287 --> 02:53:09,455 DEVELOPING AGAIN AT THE SAME 4629 02:53:09,455 --> 02:53:09,855 TIME. 4630 02:53:09,855 --> 02:53:12,524 I MENTIONED THAT YOU CAN USE 4631 02:53:12,524 --> 02:53:16,895 RTMS REPETITIVELY, MULTIPLE 4632 02:53:16,895 --> 02:53:18,197 STIMULATIONS O EXCITE OR 4633 02:53:18,197 --> 02:53:21,200 INHIBIT. 4634 02:53:21,200 --> 02:53:24,269 HERE IS A THIS IS LOOKING AT 4635 02:53:24,269 --> 02:53:26,372 ADULT RTMS STUDIES AND CAME UP 4636 02:53:26,372 --> 02:53:28,240 WITH THE CONCLUSION THAT THE 4637 02:53:28,240 --> 02:53:30,642 MAJORITY OF THE ARTICLES REPORT 4638 02:53:30,642 --> 02:53:32,044 THERE WERE POTENTIAL 4639 02:53:32,044 --> 02:53:34,279 IMPROVEMENTS IN MOTOR FUNCTION 4640 02:53:34,279 --> 02:53:35,581 AND ENCOURAGES MORE OF THESE 4641 02:53:35,581 --> 02:53:37,583 STUDIES TO ACTUALLY LOOK AT 4642 02:53:37,583 --> 02:53:40,686 RCTs AND THE OUTCOMES OF USING 4643 02:53:40,686 --> 02:53:40,886 RTMS. 4644 02:53:40,886 --> 02:53:43,155 IN OUR OWN LAB, WE'VE DONE AN 4645 02:53:43,155 --> 02:53:44,656 RTMS STUDY WITH CHILDREN WHO 4646 02:53:44,656 --> 02:53:46,692 HAVE EARLY BRAIN INJURY AND 4647 02:53:46,692 --> 02:53:50,095 RESULT IN CEREBRAL PALSY FUNDED 4648 02:53:50,095 --> 02:53:51,397 OBAMA SAM ULIS CHALLENGE GRANT 4649 02:53:51,397 --> 02:53:52,931 AND THERE WERE SIGNIFICANT 4650 02:53:52,931 --> 02:53:55,134 IMPROVEMENTS IN HAND CHILDREN 4651 02:53:55,134 --> 02:53:57,703 FOR CHILDREN WHO HAD THE REAL 4652 02:53:57,703 --> 02:53:58,203 RTMS. 4653 02:53:58,203 --> 02:53:59,471 THE KIDS WERE SAFE, THERE WERE 4654 02:53:59,471 --> 02:54:00,639 NO ADVERSE EVENTS. 4655 02:54:00,639 --> 02:54:02,608 AND ALTHOUGH IT WAS CHALLENGING 4656 02:54:02,608 --> 02:54:04,376 TO ENROLL, THERE WAS A VERY HIGH 4657 02:54:04,376 --> 02:54:05,544 RETENTION OF GOOD TOLERANCE OF 4658 02:54:05,544 --> 02:54:07,212 THE ACTIVITY. 4659 02:54:07,212 --> 02:54:10,716 I'LL SHOW YOU A VIDEO OF ONE OF 4660 02:54:10,716 --> 02:54:11,550 THE INDIVIDUALS WHO PARTICIPATED 4661 02:54:11,550 --> 02:54:12,985 IN THAT STUDY AND HER INITIAL 4662 02:54:12,985 --> 02:54:15,487 GOAL WAS TO PUT A PONYTAIL IN 4663 02:54:15,487 --> 02:54:17,389 HER HAIR BY HERSELF SO WHEN SHE 4664 02:54:17,389 --> 02:54:19,224 WENT OFF TO COLLEGE SHE COULD DO 4665 02:54:19,224 --> 02:54:20,459 IT WITHOUT HAVING SOMEONE ASSIST 4666 02:54:20,459 --> 02:54:22,361 HER AND IN HER COMMENT AT THE 4667 02:54:22,361 --> 02:54:24,263 END WAS, IT MIGHT NOT BE PRETTY 4668 02:54:24,263 --> 02:54:29,935 BUT I DID IT BY MYSELF. 4669 02:54:29,935 --> 02:54:31,270 LOOKING AT LONGITUDINAL OUTCOMES 4670 02:54:31,270 --> 02:54:33,038 AND WE DID IT AFTER THE STUDY 4671 02:54:33,038 --> 02:54:35,140 LOOKING AT TWO TO FOUR YEARS 4672 02:54:35,140 --> 02:54:37,042 AFTER AND FOUND NO SIGNIFICANT 4673 02:54:37,042 --> 02:54:38,811 DIFFERENCES IN TERMS OF OUTCOMES 4674 02:54:38,811 --> 02:54:40,446 AND NO ADVERSE EVENTS THAT WERE 4675 02:54:40,446 --> 02:54:42,648 A TYPICAL TO THE AGE RANGE IN 4676 02:54:42,648 --> 02:54:44,249 WHICH THESE INDIVIDUALS WERE. 4677 02:54:44,249 --> 02:54:45,884 IT'S HELPFUL TO SEE THIS WAS 4678 02:54:45,884 --> 02:54:47,719 SAFE STUDY AND FURTHER 4679 02:54:47,719 --> 02:54:49,154 LONGITUDINAL STUDIES NEEDED TO 4680 02:54:49,154 --> 02:54:51,256 BE DONE. 4681 02:54:51,256 --> 02:54:52,324 TRANCE CRANIAL DIRECTING CURRENT 4682 02:54:52,324 --> 02:54:53,158 STIM YOU LACE ALLOWS US TO 4683 02:54:53,158 --> 02:54:54,459 INFLUENCE WHAT IS HAPPENING WITH 4684 02:54:54,459 --> 02:54:55,694 BRAIN ACTIVITY. 4685 02:54:55,694 --> 02:54:57,062 IT'S PORTABLE AND IT HAS MUCH 4686 02:54:57,062 --> 02:55:02,868 LESS RISK FOR ADVERSE EVENTS AND 4687 02:55:02,868 --> 02:55:05,237 ADULT STUDIES HAVE BEEN DONE 4688 02:55:05,237 --> 02:55:07,472 FROM 14 ADULT PATIENTS COMBINING 4689 02:55:07,472 --> 02:55:09,107 TDCS WITH CONSTRAINT INDUCED 4690 02:55:09,107 --> 02:55:10,409 THERAPY AND FOUND ALTHOUGH THERE 4691 02:55:10,409 --> 02:55:11,810 WERE IMPROVEMENTS IN BOTH 4692 02:55:11,810 --> 02:55:13,111 GROUPS, THE GAINS WERE LARGER IN 4693 02:55:13,111 --> 02:55:15,614 THE ACTIVE TDCS STUDY AND WE DID 4694 02:55:15,614 --> 02:55:18,116 THE SAME WITH A NIH AND NINDS 4695 02:55:18,116 --> 02:55:21,186 KO1 STUDY LOOKING AT TDCS WITH 4696 02:55:21,186 --> 02:55:22,621 CONSTRAINT INDUCED THERAPY AND 4697 02:55:22,621 --> 02:55:24,623 THE CIRCUITRY, THE WEIGHT OF THE 4698 02:55:24,623 --> 02:55:27,659 BRAIN WAS DEVELOPING AND 4699 02:55:27,659 --> 02:55:28,360 RECOVERING AT THE SAME TIME 4700 02:55:28,360 --> 02:55:30,829 INFLUENCED HOW A CHILD RESPONDED 4701 02:55:30,829 --> 02:55:32,231 TO INTERVENTIONS AND THERE WERE 4702 02:55:32,231 --> 02:55:34,566 NO ADVERSE EVENTS AND IT WAS 4703 02:55:34,566 --> 02:55:39,004 VERY GOOD T TOLERANCE. 4704 02:55:39,004 --> 02:55:42,207 KATHLEEN FRIEL HAS LOOKED AT 4705 02:55:42,207 --> 02:55:43,008 ROBOTICS IN AN ADULT WITH 4706 02:55:43,008 --> 02:55:44,209 CEREBRAL PALSY WHO HAD 36 4707 02:55:44,209 --> 02:55:48,847 SESSIONS OF USING TDCS TO EXCITE 4708 02:55:48,847 --> 02:55:50,182 THE CORTEX COMBINED WITH AN HOUR 4709 02:55:50,182 --> 02:55:52,184 OF INTERACTIVE ROBOTIC TRAINING 4710 02:55:52,184 --> 02:55:53,886 AND FOUND IMPROVEMENTS NOT ONLY 4711 02:55:53,886 --> 02:55:56,221 IN TERMS OF THE ABILITY FOR THE 4712 02:55:56,221 --> 02:55:57,656 INDIVIDUAL TO MOVE WITH THE 4713 02:55:57,656 --> 02:55:59,558 ROBOT AND DRAW, BUT ALSO, IN 4714 02:55:59,558 --> 02:56:02,561 TERMS OF THEIR MOTOR MAP AND THE 4715 02:56:02,561 --> 02:56:04,563 EXPANSION OF INCREASING SIZE AND 4716 02:56:04,563 --> 02:56:05,864 EXCITE ABILITY AFTER THE 4717 02:56:05,864 --> 02:56:06,098 THERAPY. 4718 02:56:06,098 --> 02:56:07,533 THE LAST THING I'LL TALK ABOUT 4719 02:56:07,533 --> 02:56:14,139 IS THE VAGAL NERVE, WE'RE CARING 4720 02:56:14,139 --> 02:56:17,643 IN ADULT STROKE WITH VNS WITH 4721 02:56:17,643 --> 02:56:18,277 ROW HABITATION AND THROUGH THAT 4722 02:56:18,277 --> 02:56:19,878 ON THE PAR HE HAVE RAL LEVEL 4723 02:56:19,878 --> 02:56:21,580 THEY FOUND IN THIS STUDY THERE 4724 02:56:21,580 --> 02:56:25,851 WERE CLINICAL MEANINGFUL RATES 4725 02:56:25,851 --> 02:56:31,223 WERE DOUBLED WITH VNS 4726 02:56:31,223 --> 02:56:33,025 REHABILITATION AND 50% HAD A 4727 02:56:33,025 --> 02:56:34,660 RESPONSE AT DAY ONE POST THERAPY 4728 02:56:34,660 --> 02:56:36,295 SO THIS WAS ACTUALLY A STUDY 4729 02:56:36,295 --> 02:56:37,963 THAT RESULTED IN THE FDA 4730 02:56:37,963 --> 02:56:40,565 APPROVAL OF THIS TYPE OF THERAPY 4731 02:56:40,565 --> 02:56:43,235 IN AUGUST OF 2021 AND IT'S NOW 4732 02:56:43,235 --> 02:56:43,835 BEING USED. 4733 02:56:43,835 --> 02:56:45,837 IF YOU TRANSLATE THIS TO INFANTS 4734 02:56:45,837 --> 02:56:48,140 IN TERMS OF INFANTS CAN EARLY 4735 02:56:48,140 --> 02:56:49,808 BRAIN INJURIES, DOUGH JENKINS 4736 02:56:49,808 --> 02:56:52,744 AND HER DEEM HAVE DONE A STUDY 4737 02:56:52,744 --> 02:56:58,050 IN 14 INFANTS, 11 PREMATURE AND 4738 02:56:58,050 --> 02:57:00,385 THREE WITH -- THE GOAL WAS 4739 02:57:00,385 --> 02:57:01,920 ACTUALLY TO KEEP THE INFANTS 4740 02:57:01,920 --> 02:57:04,256 SAFE IF THEY USED VNS AND 4741 02:57:04,256 --> 02:57:06,124 INCREASE FEEDING VOLUMES SO THEY 4742 02:57:06,124 --> 02:57:07,960 CAN HAVE ADEQUATE WEIGHT GAIN TO 4743 02:57:07,960 --> 02:57:11,096 BE DISCHARGED WITHOUT SURGICAL 4744 02:57:11,096 --> 02:57:12,364 INTERVENTION AND G-TUBE. 4745 02:57:12,364 --> 02:57:16,735 THERE WERE NO ADVERSE EVENTS AND 4746 02:57:16,735 --> 02:57:18,470 EIGHT OF THE RECEIVED ADEQUATE 4747 02:57:18,470 --> 02:57:20,472 FEEDING VOLUMES WITHOUT THE 4748 02:57:20,472 --> 02:57:21,907 G-TUBE AND SIGNIFICANT INCREASES 4749 02:57:21,907 --> 02:57:24,042 IN FEEDING VOLUME RA 4750 02:57:24,042 --> 02:57:25,444 TRAJECTORIES SO THE STIMULATION 4751 02:57:25,444 --> 02:57:27,446 REALLY DID HAVE A CLINICAL 4752 02:57:27,446 --> 02:57:28,380 MEANINGFUL EFFECT. 4753 02:57:28,380 --> 02:57:29,948 SO HOW DOES THIS RELATE TO THE 4754 02:57:29,948 --> 02:57:31,216 STRATEGIC PLAN IN THE WORK THAT 4755 02:57:31,216 --> 02:57:32,985 I JUST BRIEFLY SHARED OVER 4756 02:57:32,985 --> 02:57:35,120 ADULTS AND PEDIATRICS IN 4757 02:57:35,120 --> 02:57:36,288 CORTICAL PLASTICITY? 4758 02:57:36,288 --> 02:57:37,556 WELL ONE IS WE TALKED ABOUT SOME 4759 02:57:37,556 --> 02:57:39,424 OF THE CRITICAL PERIODS OF BRAIN 4760 02:57:39,424 --> 02:57:40,726 AND MOTOR DEVELOPMENT AND 4761 02:57:40,726 --> 02:57:42,127 LOOKING ACROSS THE LIFESPAN OF 4762 02:57:42,127 --> 02:57:43,528 THOSE AND WE'VE CONSIDERED 4763 02:57:43,528 --> 02:57:45,564 NEURAL PLASTIC PROMOTING 4764 02:57:45,564 --> 02:57:46,398 INTERVENTIONS FROM THE OTHER 4765 02:57:46,398 --> 02:57:47,366 FIELDS SO THERE ARE DIFFERENT 4766 02:57:47,366 --> 02:57:49,468 WAYS TO ACTUALLY COMBINE 4767 02:57:49,468 --> 02:57:52,804 REHABILITATION WITH OUR NEURO 4768 02:57:52,804 --> 02:57:53,605 MODULATORY ALONE. 4769 02:57:53,605 --> 02:57:56,074 WE'VE CONSIDERED THE ENTIRE 4770 02:57:56,074 --> 02:57:57,843 LIFESPAN FOR LEVERAGING NEURO 4771 02:57:57,843 --> 02:57:59,244 PLASTICITY AND AS WELL AS 4772 02:57:59,244 --> 02:58:00,912 COMBINATION THERAPY SUCH AS NON 4773 02:58:00,912 --> 02:58:03,148 INVASIVE BRAIN STIMULATION AND 4774 02:58:03,148 --> 02:58:03,949 CONSTRAINT-INDUCED THERAPY FOR 4775 02:58:03,949 --> 02:58:06,218 OUR TARGETING OF DIFFERENT 4776 02:58:06,218 --> 02:58:06,485 PATHWAYS. 4777 02:58:06,485 --> 02:58:07,886 AND ALSO TRYING TO ACCELERATE IF 4778 02:58:07,886 --> 02:58:10,555 NOT ACTUALLY ACHIEVE A BENCH 4779 02:58:10,555 --> 02:58:13,258 SIDE APPROACH FOR TRANSLATIONAL 4780 02:58:13,258 --> 02:58:14,559 INTRA SELECTIONS THAT SOON IF 4781 02:58:14,559 --> 02:58:16,461 NOT HAVE NOT ALREADY BEEN 4782 02:58:16,461 --> 02:58:18,263 TARGETED SPECIFICALLY FOR 4783 02:58:18,263 --> 02:58:18,930 CEREBRAL PALSY. 4784 02:58:18,930 --> 02:58:20,565 SO THIS IS AN INDIVIDUAL WHO WAS 4785 02:58:20,565 --> 02:58:22,567 WORKING WITH US IN THE NICU AND 4786 02:58:22,567 --> 02:58:24,102 SHE'S TWO AND HER T-SHIRT SAYS 4787 02:58:24,102 --> 02:58:27,406 I'M THIS MANY WITH FINGERS UP. 4788 02:58:27,406 --> 02:58:29,041 THE CORTICAL PLASTICITY AND 4789 02:58:29,041 --> 02:58:30,575 RECOVERY TO UNDERSTAND HOW AS AN 4790 02:58:30,575 --> 02:58:32,711 INDIVIDUAL WITH EARLY PERINATAL 4791 02:58:32,711 --> 02:58:34,246 BRAIN INJURY OR LATER IN THEIR 4792 02:58:34,246 --> 02:58:36,448 LIVES, HOW IS THAT PLASTICITY 4793 02:58:36,448 --> 02:58:37,616 TRANSLATE FROM ADULT TO 4794 02:58:37,616 --> 02:58:39,151 PEDIATRIC POPULATIONS. 4795 02:58:39,151 --> 02:58:40,619 I WANT TO THANK MY ENTIRE TEAM 4796 02:58:40,619 --> 02:58:41,987 WHO DID THE MAJORITY OF THE WORK 4797 02:58:41,987 --> 02:58:43,388 THAT I JUST SHARED AND WHO I 4798 02:58:43,388 --> 02:58:44,356 HAVE THE GREAT PLEASURE OF 4799 02:58:44,356 --> 02:58:46,191 WORKING WITH BOTH MY COLLEAGUES 4800 02:58:46,191 --> 02:58:46,458 AS WELL. 4801 02:58:46,458 --> 02:58:48,527 ALL OF MY COLLEAGUES AS WELL. 4802 02:58:48,527 --> 02:58:49,594 SO, I THANK YOU VERY MUCH FOR 4803 02:58:49,594 --> 02:58:51,129 YOUR ATTENTION AND THE 4804 02:58:51,129 --> 02:58:52,164 OPPORTUNITY TO SHARE AND TO 4805 02:58:52,164 --> 02:59:00,272 LEARN MORE FROM YOU AS WELL. 4806 02:59:00,272 --> 02:59:02,140 >> THANK YOU, EVERYBODY. 4807 02:59:02,140 --> 02:59:04,309 ALL OF THE PRESENTATIONS TODAY 4808 02:59:04,309 --> 02:59:06,912 HAVE BEEN ABSOLUTELY FANTASTIC. 4809 02:59:06,912 --> 02:59:10,782 AND I WANT TO THANK ALL OF OUR 4810 02:59:10,782 --> 02:59:13,485 SPEAKERS FOR THEIR 4811 02:59:13,485 --> 02:59:14,386 PARTICIPATION. 4812 02:59:14,386 --> 02:59:17,956 SO, TODAY WE'VE ACTUALLY HEARD 4813 02:59:17,956 --> 02:59:21,660 PRESENTATIONS ABOUT THE NIH 4814 02:59:21,660 --> 02:59:23,261 CEREBRAL PALSY RESEARCH FUNDING 4815 02:59:23,261 --> 02:59:23,528 PORTFOLIO. 4816 02:59:23,528 --> 02:59:25,163 ONE OF THE THINGS THAT YOU SAW 4817 02:59:25,163 --> 02:59:27,866 WAS THAT THERE WAS A SUBSTANTIAL 4818 02:59:27,866 --> 02:59:30,602 INCREASE IN THE NUMBER OF 4819 02:59:30,602 --> 02:59:32,304 TRAINEES THAT ARE BEING FUNDED 4820 02:59:32,304 --> 02:59:37,876 BY NIH TO PERFORM CEREBRAL PALSY 4821 02:59:37,876 --> 02:59:38,343 RESEARCH. 4822 02:59:38,343 --> 02:59:40,645 SORT OF SEEDING THE FIELD FOR 4823 02:59:40,645 --> 02:59:42,647 NEXT GENERATIONS. 4824 02:59:42,647 --> 02:59:45,117 WE ALSO HEARD A WONDERFUL 4825 02:59:45,117 --> 02:59:47,719 PRESENTATION FROM Ms. ANDERSON 4826 02:59:47,719 --> 02:59:50,322 ABOUT WHAT IT'S LIKE TO LIVE 4827 02:59:50,322 --> 02:59:51,857 WITH CEREBRAL PALSY AND 4828 02:59:51,857 --> 02:59:53,992 PARTICIPATE IN AN NIH-FUNDED 4829 02:59:53,992 --> 02:59:56,828 CLINICAL RESEARCH ENTERPRISE. 4830 02:59:56,828 --> 03:00:02,501 WE ALSO HEARD ABOUT HOW NOVEL 4831 03:00:02,501 --> 03:00:04,770 ANIMAL MODELS CAN BE USED TO 4832 03:00:04,770 --> 03:00:08,240 INFORM UNDERSTANDING ABOUT 4833 03:00:08,240 --> 03:00:08,874 CEREBRAL PALSY FUNCTIONAL 4834 03:00:08,874 --> 03:00:10,308 DEFICITS, GENETICS AND ACTUALLY 4835 03:00:10,308 --> 03:00:13,845 AID IN THE DEVELOPMENT OF NEW 4836 03:00:13,845 --> 03:00:14,346 THERAPIES. 4837 03:00:14,346 --> 03:00:16,615 WE'VE HEARD ABOUT ADVANCES IN 4838 03:00:16,615 --> 03:00:18,984 USING NEUROIMAGING POTENTIALLY 4839 03:00:18,984 --> 03:00:24,723 TO DIAGNOSE CP EARLIER AND WE 4840 03:00:24,723 --> 03:00:28,293 ALSO HEARD ABOUT IMPORTANT, HOW 4841 03:00:28,293 --> 03:00:29,961 IMPORTANT CENTURY MOTOR FEEDBACK 4842 03:00:29,961 --> 03:00:32,564 IS FOR IMPROVING LIMB FUNCTION 4843 03:00:32,564 --> 03:00:34,566 AND HOW NEURO PLASTICITY IN 4844 03:00:34,566 --> 03:00:36,535 DIFFERENT FORMS OF NEURO 4845 03:00:36,535 --> 03:00:39,805 MODULATION CAN BE LEVERAGED TO 4846 03:00:39,805 --> 03:00:44,142 ENHANCE CEREBRAL PALSY RECOVERY. 4847 03:00:44,142 --> 03:00:47,078 SO, WE'VE COVERED A PRETTY WIDE 4848 03:00:47,078 --> 03:00:48,914 PIECE OF LANDSCAPE HERE DURING 4849 03:00:48,914 --> 03:00:51,116 THE COURSE OF TODAY. 4850 03:00:51,116 --> 03:00:53,118 AND ALL SIX OF THESE 4851 03:00:53,118 --> 03:00:55,821 PRESENTATIONS THAT WE'VE HEARD 4852 03:00:55,821 --> 03:00:59,291 HAVE REALLY KIND OF EMPHASIZED 4853 03:00:59,291 --> 03:01:03,094 HOW THESE ELEMENTS FEED INTO THE 4854 03:01:03,094 --> 03:01:06,565 STRATEGIC PLAN THAT WE PUBLISHED 4855 03:01:06,565 --> 03:01:07,132 IN 2017. 4856 03:01:07,132 --> 03:01:09,734 SO, WHAT I WANT TO DO AT THIS 4857 03:01:09,734 --> 03:01:11,736 PARTICULAR POINT, IS KIND OF 4858 03:01:11,736 --> 03:01:15,974 TAKE A STEP BACK AND PULL UP 4859 03:01:15,974 --> 03:01:18,810 SOME OF THE QUESTIONS FROM OUR 4860 03:01:18,810 --> 03:01:20,912 QUESTION AND ANSWER AUDIENCE. 4861 03:01:20,912 --> 03:01:22,414 THAT WERE ASKED VIA THE QUESTION 4862 03:01:22,414 --> 03:01:26,484 AND ANSWER PERIOD. 4863 03:01:26,484 --> 03:01:28,019 IF ALL OF OUR SPEAKERS FROM 4864 03:01:28,019 --> 03:01:29,788 TODAY, ALL SIX, CAN ACTUALLY 4865 03:01:29,788 --> 03:01:36,795 TURN ON THEIR CAMERAS, AND I 4866 03:01:36,795 --> 03:01:37,963 WILL ASK SOME QUESTIONS AND YOU 4867 03:01:37,963 --> 03:01:40,298 CAN ANSWER THEM DIRECTLY IF YOU 4868 03:01:40,298 --> 03:01:40,865 DON'T MIND. 4869 03:01:40,865 --> 03:01:44,436 SO I'M GOING TO ASK MY 4870 03:01:44,436 --> 03:01:46,838 COLLEAGUE, TO ALSO HELP ME 4871 03:01:46,838 --> 03:01:48,039 IDENTIFY SOME OF THESE QUESTIONS 4872 03:01:48,039 --> 03:01:49,641 GOING FORWARD. 4873 03:01:49,641 --> 03:01:52,143 SO PLEASE FEEL FREE TO CHIME IN 4874 03:01:52,143 --> 03:01:57,082 IF I MISS ANYTHING. 4875 03:01:57,082 --> 03:02:00,752 SO, LET ME START FIRST BY ASKING 4876 03:02:00,752 --> 03:02:05,523 A COUPLE OF QUESTIONS TO BHOOMA 4877 03:02:05,523 --> 03:02:08,493 SINCE SHE WAS OUR KICK-OFF 4878 03:02:08,493 --> 03:02:10,528 SPEAKER FOR THE SIX 4879 03:02:10,528 --> 03:02:10,862 PRESENTATIONS. 4880 03:02:10,862 --> 03:02:15,166 ONE OF THE QUESTIONS WAS, IS 4881 03:02:15,166 --> 03:02:18,003 MOVEMENT CAPTURE IN YOUR MOUSE 4882 03:02:18,003 --> 03:02:21,039 MODELS ALSO DONE WITH WEIGHT 4883 03:02:21,039 --> 03:02:22,874 BEARING AND DOES IT QUANTIFY OR 4884 03:02:22,874 --> 03:02:26,311 DOES IT RELATE TO THE CLINICAL 4885 03:02:26,311 --> 03:02:29,047 SCALE THAT YOU ACTUALLY USE? 4886 03:02:29,047 --> 03:02:31,283 >> YEAH, THANK YOU FOR THAT 4887 03:02:31,283 --> 03:02:31,549 QUESTION. 4888 03:02:31,549 --> 03:02:33,151 THANK YOU FOR ALL OF THESE 4889 03:02:33,151 --> 03:02:33,485 TALKS. 4890 03:02:33,485 --> 03:02:36,087 IT'S GREAT TO LEARN FROM ALL OF 4891 03:02:36,087 --> 03:02:37,756 YOU, LEARN FROM EACH OTHER. 4892 03:02:37,756 --> 03:02:39,758 SO, I'M EXCITED TO BE HERE. 4893 03:02:39,758 --> 03:02:44,930 THE ANSWER TO THAT QUESTION, SO, 4894 03:02:44,930 --> 03:02:48,099 WE LOOKED AT SPECIFICALLY FEAR 4895 03:02:48,099 --> 03:02:50,635 TURES OF DYSTONIA THAT WE 4896 03:02:50,635 --> 03:02:51,936 DERIVED DIRECTLY FROM THE 4897 03:02:51,936 --> 03:02:52,437 CLINIC. 4898 03:02:52,437 --> 03:02:54,306 WE DO OUR BEST TO LOOK FOR 4899 03:02:54,306 --> 03:02:57,876 CLINICALLY RELEVANT FEATURES OF 4900 03:02:57,876 --> 03:03:00,712 THE MOTOR PHENOTYPES WE STUDY 4901 03:03:00,712 --> 03:03:05,317 AND DYSTONIA IS MY. 4902 03:03:05,317 --> 03:03:07,118 IT'S QUANTIFY DYSTONIA PEOPLE SO 4903 03:03:07,118 --> 03:03:08,620 WE CAN TRANSLATE THAT TO MICE IN 4904 03:03:08,620 --> 03:03:11,323 A CLINICALLY RELEVANT WAY. 4905 03:03:11,323 --> 03:03:14,726 WE LOOK AT MICE SUSPENSION 4906 03:03:14,726 --> 03:03:16,561 BECAUSE THAT IS THE WAY DYSTONIA 4907 03:03:16,561 --> 03:03:18,930 HAS BEEN CLASSIFIED IN MICE AND 4908 03:03:18,930 --> 03:03:22,000 WE ALSO LOOK AT IT DURING 4909 03:03:22,000 --> 03:03:26,538 TREADMILL WALKING SO DURING 4910 03:03:26,538 --> 03:03:28,273 WEIGHT-BEARING, DURING GAIT IN 4911 03:03:28,273 --> 03:03:35,380 MICE AND WE DO THE RANGE OF 4912 03:03:35,380 --> 03:03:37,082 CONVENTIONAL WE USE TO ASSESS 4913 03:03:37,082 --> 03:03:37,882 MICE AS WELL. 4914 03:03:37,882 --> 03:03:39,584 WE WANT TO BE CAREFUL THAT IT'S 4915 03:03:39,584 --> 03:03:42,787 VERY DIFFICULT TO ASSESS WHAT A 4916 03:03:42,787 --> 03:03:43,421 FUNCTIONALLY RELEVANT GOAL IS 4917 03:03:43,421 --> 03:03:47,759 FOR A MOUSE AND TO HAVE THAT BE 4918 03:03:47,759 --> 03:03:49,060 TRANSLATIONAL TO PEOPLE. 4919 03:03:49,060 --> 03:03:52,931 SO, WE ALSO KNOW THAT OPEN FIELD 4920 03:03:52,931 --> 03:03:54,866 WALKING IN MICE THAT YOU TAKE A 4921 03:03:54,866 --> 03:03:57,035 LOT OF BRAIN INJURIES TO 4922 03:03:57,035 --> 03:03:59,204 ACTUALLY GET ANY SORT OF EFFECT. 4923 03:03:59,204 --> 03:04:02,273 SO, WE WANT TO BE VERY CAREFUL 4924 03:04:02,273 --> 03:04:04,275 ABOUT USING CLINICALLY RELEVANT 4925 03:04:04,275 --> 03:04:05,944 STRATEGIES TO ASSESS MOTOR 4926 03:04:05,944 --> 03:04:09,314 OUTCOMES IN MICE BUT ALSO BE 4927 03:04:09,314 --> 03:04:11,216 REALISTIC ABOUT WHAT FUNCTION 4928 03:04:11,216 --> 03:04:11,750 REALLY MEANS WHEN YOU ARE 4929 03:04:11,750 --> 03:04:17,389 TALKING ABOUT A MOUSE COMPARED A 4930 03:04:17,389 --> 03:04:17,622 PERSON. 4931 03:04:17,622 --> 03:04:19,924 >> GREAT, THANK YOU. 4932 03:04:19,924 --> 03:04:21,259 WONDERFUL ANSWER. 4933 03:04:21,259 --> 03:04:24,129 SO, ANOTHER QUESTION FOR YOU 4934 03:04:24,129 --> 03:04:26,264 IS -- DO YOU FIND OR BELIEVE 4935 03:04:26,264 --> 03:04:28,500 THAT WHITE MATTER DEVELOPMENT IS 4936 03:04:28,500 --> 03:04:31,336 EFFECTED IN YOUR HYPOXY MODEL? 4937 03:04:31,336 --> 03:04:33,004 AND THAT IT MIGHT CONTRIBUTE TO 4938 03:04:33,004 --> 03:04:34,973 THE DYSTONIA AND OTHER 4939 03:04:34,973 --> 03:04:38,143 PHENOTYPES THAT YOU OBSERVED? 4940 03:04:38,143 --> 03:04:39,411 >> YES. 4941 03:04:39,411 --> 03:04:40,979 SO, WHITE MATTER INJURIES 4942 03:04:40,979 --> 03:04:43,948 ACTUALLY PRETTY LIMITED IN OUR 4943 03:04:43,948 --> 03:04:46,451 MODEL IN TERMS OF NEURONAL LOSS 4944 03:04:46,451 --> 03:04:49,554 AND LONGSTANDING GLEOSIS AND 4945 03:04:49,554 --> 03:04:51,990 SIZE MEASUREMENTS SO THERE'S NO 4946 03:04:51,990 --> 03:04:56,528 DIFFERENCE IN CORTICAL ROI SIZE 4947 03:04:56,528 --> 03:04:57,862 AND THERE'S NO SIGNIFICANCE 4948 03:04:57,862 --> 03:05:00,131 DIFFERENCE IN THE NUMBER. 4949 03:05:00,131 --> 03:05:01,433 SO, COULD THERE BE SOME DEGREE 4950 03:05:01,433 --> 03:05:03,468 OF WHITE MATTER INJURIES THAT WE 4951 03:05:03,468 --> 03:05:06,171 HAVEN'T QUANTIFIED USING KIND OF 4952 03:05:06,171 --> 03:05:09,040 PATHOLOGIC METHODS? 4953 03:05:09,040 --> 03:05:10,475 SURE. 4954 03:05:10,475 --> 03:05:13,144 IS IT A STILL A SIGNIFICANT 4955 03:05:13,144 --> 03:05:14,579 CONTRIBUTE OR TO MOTOR 4956 03:05:14,579 --> 03:05:16,614 DYSFUNCTION, EVEN BEYOND THE 4957 03:05:16,614 --> 03:05:20,385 SOURCE OF GROSS MEASURES? 4958 03:05:20,385 --> 03:05:23,421 YES IT COULD. 4959 03:05:23,421 --> 03:05:24,789 I THINK MAYBE PERHAPS PART OF 4960 03:05:24,789 --> 03:05:28,259 THE HIDDEN SUBJECTS IN THAT 4961 03:05:28,259 --> 03:05:30,028 QUESTION IS, HOW MUCH ARE WE 4962 03:05:30,028 --> 03:05:33,264 DIFFERENTIATING BETWEEN DYSTONIA 4963 03:05:33,264 --> 03:05:35,266 PLASTICITY IN THESE MODELS AND 4964 03:05:35,266 --> 03:05:37,602 THERE ARE A LOT OF DIFFERENT EMG 4965 03:05:37,602 --> 03:05:43,842 STUDIES THAT WE'VE DONE AND WAYS 4966 03:05:43,842 --> 03:05:45,110 WE'VE DEVELOPED IT AND WE'VE 4967 03:05:45,110 --> 03:05:48,146 APPLIED TO THE MICE WHICH I'M 4968 03:05:48,146 --> 03:05:50,815 HAPPY TO TALK MORE ABOUT, I CAN 4969 03:05:50,815 --> 03:05:53,184 DO ANOTHER TALK ON THAT. 4970 03:05:53,184 --> 03:05:54,486 WE DO TROY AND DIFFERENTIATE 4971 03:05:54,486 --> 03:05:56,955 BETWEEN THOSE FEATURES TOO. 4972 03:05:56,955 --> 03:05:58,490 SHORT ANSWER IS IS THERE A LOT 4973 03:05:58,490 --> 03:05:59,324 OF WHITE MATTER INJURY IN 4974 03:05:59,324 --> 03:06:02,127 THISSED MONTHEL, NO. 4975 03:06:02,127 --> 03:06:03,661 AND THAT'S CONSISTENT WITH 4976 03:06:03,661 --> 03:06:05,230 PEOPLE OBSERVED PREVIOUSLY WITH 4977 03:06:05,230 --> 03:06:08,633 MODELS LIKE THIS AS WELL. 4978 03:06:08,633 --> 03:06:09,000 >> Jim: GREAT. 4979 03:06:09,000 --> 03:06:10,768 THANK YOU. 4980 03:06:10,768 --> 03:06:15,006 SO, THE NEXT QUESTION IS FOR 4981 03:06:15,006 --> 03:06:17,609 Dr. KRUER. 4982 03:06:17,609 --> 03:06:19,611 AND HAS ANYONE STUDIED THE 4983 03:06:19,611 --> 03:06:22,113 INCIDENTS OF CP IN CHILDREN WITH 4984 03:06:22,113 --> 03:06:25,416 A PARENT WITH CEREBRAL PALSY? 4985 03:06:25,416 --> 03:06:28,553 IS IT HIGHER THAN TYPICAL? 4986 03:06:28,553 --> 03:06:31,856 IS STUDYING KIDS OF PARENTS WITH 4987 03:06:31,856 --> 03:06:36,194 CEREBRAL PALSY LIKELY TO MAKE AN 4988 03:06:36,194 --> 03:06:36,461 IMPACT? 4989 03:06:36,461 --> 03:06:40,965 >> YEAH, ALSO THANK YOU FOR THE 4990 03:06:40,965 --> 03:06:42,033 OPPORTUNITY TO BE HERE WITH ALL 4991 03:06:42,033 --> 03:06:42,834 OF YOU TODAY. 4992 03:06:42,834 --> 03:06:44,469 IT'S BEEN AN EXCITING WORKSHOP. 4993 03:06:44,469 --> 03:06:47,405 I'M LOOKING FORWARD TO THE 4994 03:06:47,405 --> 03:06:48,973 SECOND HALF. 4995 03:06:48,973 --> 03:06:51,176 AS FAR AS THE QUESTION GOES, THE 4996 03:06:51,176 --> 03:06:53,278 SHORT ANSWER IS YES, THAT HAS 4997 03:06:53,278 --> 03:06:56,247 BEEN LOOKED AT IN PARTICULAR 4998 03:06:56,247 --> 03:07:00,018 THERE WAS A SCANDINAVIAN 4999 03:07:00,018 --> 03:07:02,120 POPULATION-BASED STUDY THAT WAS 5000 03:07:02,120 --> 03:07:03,187 PUBLISHED SEVEN OR EIGHT YEARS 5001 03:07:03,187 --> 03:07:04,956 AGO AT THIS POINT IN TIME THAT 5002 03:07:04,956 --> 03:07:07,358 LOOKED AT FAMILIAL OCCURRENCE OF 5003 03:07:07,358 --> 03:07:08,459 CEREBRAL PALSY. 5004 03:07:08,459 --> 03:07:11,062 ALTHOUGH WE TYPICALLY THINK 5005 03:07:11,062 --> 03:07:14,933 ABOUT CEREBRAL PALSY AS BEING A 5006 03:07:14,933 --> 03:07:18,303 SPORADIC OCCURRENCE, OVER TIME 5007 03:07:18,303 --> 03:07:19,504 WE'RE RECOGNIZING THERE'S A 5008 03:07:19,504 --> 03:07:21,306 DIVERSE SET OF GENETIC CHANGES 5009 03:07:21,306 --> 03:07:22,974 THAT CAN LEAD TO CEREBRAL PALSY 5010 03:07:22,974 --> 03:07:25,009 AND AS I MENTIONED, AND OTHERS 5011 03:07:25,009 --> 03:07:27,478 HAVE MENTIONED THERE ARE BOTH 5012 03:07:27,478 --> 03:07:31,249 GENETIC AND OTHER FACTORS THAT 5013 03:07:31,249 --> 03:07:32,517 WILL INTERACTS TO LEAD TO 5014 03:07:32,517 --> 03:07:32,984 CEREBRAL PALSY. 5015 03:07:32,984 --> 03:07:35,687 SO, WE DO KNOW FOR EXAMPLE THAT 5016 03:07:35,687 --> 03:07:38,990 IN OFFSPRING OF PARENTS THAT 5017 03:07:38,990 --> 03:07:41,593 HAVE DIAGNOSIS OF CEREBRAL PALSY 5018 03:07:41,593 --> 03:07:43,962 THE INCIDENTS IN THEIR CHILDREN 5019 03:07:43,962 --> 03:07:45,663 IS HIGHER AND AT LEAST SOME OF 5020 03:07:45,663 --> 03:07:48,566 THAT IS THOUGHT TO BE DUE TO 5021 03:07:48,566 --> 03:07:50,535 MUTATIONS THAT CAN POTENTIALLY 5022 03:07:50,535 --> 03:07:53,371 CROSS GENERATIONAL LINES AND BE 5023 03:07:53,371 --> 03:07:54,439 INHERITED, FOR EXAMPLE, IN A 5024 03:07:54,439 --> 03:07:55,540 DOMINANT MATTER. 5025 03:07:55,540 --> 03:07:57,542 I THINK OVER ALL, THIS SPEAKS 5026 03:07:57,542 --> 03:07:59,544 THOUGH TO THE FACT THAT WE'RE 5027 03:07:59,544 --> 03:08:00,812 JUST SCRATCHING THE SURFACE 5028 03:08:00,812 --> 03:08:02,747 WHERE IT COMES TO THE GENETICS 5029 03:08:02,747 --> 03:08:03,715 OF CEREBRAL PALSY AND THERE'S 5030 03:08:03,715 --> 03:08:06,751 STILL A GREAT DEAL TO LEARN. 5031 03:08:06,751 --> 03:08:08,386 I THINK THAT AS I HIGHLIGHTED 5032 03:08:08,386 --> 03:08:11,456 BRIEFLY IN MY TALK, THERE'S 5033 03:08:11,456 --> 03:08:12,190 GREAT OPPORTUNITIES TO REALLY 5034 03:08:12,190 --> 03:08:14,392 DIVERSIFY THE STUDIES AND 5035 03:08:14,392 --> 03:08:19,297 CONSIDER ALL TYPES 6 INHERIT 5036 03:08:19,297 --> 03:08:20,698 DIFFERENT FAMILY STRUCTURES AND 5037 03:08:20,698 --> 03:08:24,702 DIFFERENT ETH NICE T ETHNICITIEI 5038 03:08:24,702 --> 03:08:26,204 THINK WE'LL LEARN A LOT. 5039 03:08:26,204 --> 03:08:29,107 >> Jim: THANK YOU, MICHAEL. 5040 03:08:29,107 --> 03:08:31,175 THAT WAS VERY GOOD. 5041 03:08:31,175 --> 03:08:36,247 LET ME ASK Dr. PARIKH A 5042 03:08:36,247 --> 03:08:36,514 QUESTION. 5043 03:08:36,514 --> 03:08:37,915 LET ME SEE IF I CAN FIND IT 5044 03:08:37,915 --> 03:08:38,416 HERE. 5045 03:08:38,416 --> 03:08:48,526 SORRY. 5046 03:08:49,394 --> 03:08:49,527 OOPS. 5047 03:08:49,527 --> 03:08:53,931 >> I THINK IT'S THE ONE FROM 5048 03:08:53,931 --> 03:08:54,298 HEATHER HANCOCK. 5049 03:08:54,298 --> 03:08:57,268 >> I'M HAPPY TO READ IT. 5050 03:08:57,268 --> 03:08:57,635 >> Jim: GREAT. 5051 03:08:57,635 --> 03:08:57,902 THANK YOU. 5052 03:08:57,902 --> 03:09:01,439 >> I ALSO WANT TO ECHO THE 5053 03:09:01,439 --> 03:09:02,607 COMMENTS ABOUT HOW WONDERFUL 5054 03:09:02,607 --> 03:09:03,041 THIS IS. 5055 03:09:03,041 --> 03:09:04,876 THANK YOU SO MUCH TO ALL THE 5056 03:09:04,876 --> 03:09:08,479 ORGANIZERS AND ALL THE SPEAKERS, 5057 03:09:08,479 --> 03:09:08,780 REALLY. 5058 03:09:08,780 --> 03:09:14,719 FOR THE EDUCATIONAL AND EDUCATI. 5059 03:09:14,719 --> 03:09:17,422 IF THE LEASHANCE ARE VISIBLE BUT 5060 03:09:17,422 --> 03:09:20,491 AS THE BABIES BECOME ADULTS THEY 5061 03:09:20,491 --> 03:09:21,492 DON'T SHOW ON SCANS. 5062 03:09:21,492 --> 03:09:22,627 WHY DOES THIS HAPPEN? 5063 03:09:22,627 --> 03:09:24,762 >> IT'S A GREAT QUESTION. 5064 03:09:24,762 --> 03:09:27,231 IT HAPPENS IN BABIES TOO SO OUR 5065 03:09:27,231 --> 03:09:28,966 PREMATURE BABIES IF WE IMAGE 5066 03:09:28,966 --> 03:09:30,968 THEM WEEKLY WILL SOMETIMES SEE 5067 03:09:30,968 --> 03:09:35,306 THESE LESIONS DISAPPEAR, 5068 03:09:35,306 --> 03:09:37,809 ESPECIALLY CYSTIC SO SOME 5069 03:09:37,809 --> 03:09:39,811 RECOMMEND THAT THESE PRE TERM 5070 03:09:39,811 --> 03:09:41,846 BABIES ARE IMAGED EVERY WEEK. 5071 03:09:41,846 --> 03:09:42,847 HOWEVER, IF YOU KNOW WHAT YOU 5072 03:09:42,847 --> 03:09:46,651 ARE LOOKING FOR, YOU CAN STILL 5073 03:09:46,651 --> 03:09:47,585 FINDS THOSE THINGS. 5074 03:09:47,585 --> 03:09:50,755 SO FOR EXAMPLE, IN PREEMIES AT 5075 03:09:50,755 --> 03:09:51,923 TERMS, THEY WILL OFTEN TIMES 5076 03:09:51,923 --> 03:09:55,393 HAVE BIGGER VENTRICLES SO 5077 03:09:55,393 --> 03:09:59,464 INLARGEMENT IS THE PVL. 5078 03:09:59,464 --> 03:10:01,833 AND IN ADULTS, LIKELY, WHAT 5079 03:10:01,833 --> 03:10:06,137 WE'RE SEEING IS THE BRAIN SHA 5080 03:10:06,137 --> 03:10:09,574 RINKS SO THE WHITE MATTER SO YOU 5081 03:10:09,574 --> 03:10:10,908 WILL SEE SCARRING AND THAT WHITE 5082 03:10:10,908 --> 03:10:13,277 MATTER VOLUME WILL GET SMALLER. 5083 03:10:13,277 --> 03:10:17,715 THE VENTRICLES WILL COMPENSATE 5084 03:10:17,715 --> 03:10:18,850 AND GET BIGGER. 5085 03:10:18,850 --> 03:10:20,518 IT'S MORE SUBTLE AND HARD TO 5086 03:10:20,518 --> 03:10:21,619 DETECT SO UNLESS YOU KNOW WHAT 5087 03:10:21,619 --> 03:10:23,287 YOU ARE LOOKING FOR AND YOU ARE 5088 03:10:23,287 --> 03:10:26,491 ABLE TO USE A RIGHT SEQUENCES, 5089 03:10:26,491 --> 03:10:28,259 MRI SEQUENCE TO DETECT THOSE 5090 03:10:28,259 --> 03:10:30,762 INJURIES, I WOULD SAY CERTAINLY 5091 03:10:30,762 --> 03:10:32,330 HAVING LONGITUDINAL IMAGING WILL 5092 03:10:32,330 --> 03:10:33,598 MAKE IT A LITTLE BIT MORE 5093 03:10:33,598 --> 03:10:35,500 SENSITIVE TO PICK UP THOSE 5094 03:10:35,500 --> 03:10:37,034 ABNORMALITIES. 5095 03:10:37,034 --> 03:10:38,803 OR PICKING THE IMAGES IN THE 5096 03:10:38,803 --> 03:10:40,404 SENSITIVE PERIODS OF DEVELOPMENT 5097 03:10:40,404 --> 03:10:41,939 WHEN MOST THESE INSULTS OCCUR 5098 03:10:41,939 --> 03:10:45,910 WILL ALLOW YOU TO DETECT AND PRO 5099 03:10:45,910 --> 03:10:47,245 DICTIONARY OUTCOMES MUCH MORE 5100 03:10:47,245 --> 03:10:49,046 READILY AND ALSO, I THINK USING 5101 03:10:49,046 --> 03:10:51,949 MORE ADVANCE MODALITY SUCH AS 5102 03:10:51,949 --> 03:10:53,451 DIFFUSION IMAGING WHERE YOU CAN 5103 03:10:53,451 --> 03:10:54,852 ACTUALLY LOOK AT THESE SENSORY 5104 03:10:54,852 --> 03:10:56,854 MOTOR TRACKS, I THINK WE WOULD 5105 03:10:56,854 --> 03:11:00,258 ALLOW YOU TO QUANTIFY THE INJURY 5106 03:11:00,258 --> 03:11:02,527 BETTER WHEN THESE OBVIOUSLY 5107 03:11:02,527 --> 03:11:04,162 LESIONS DISAPPEAR SO THERE ARE 5108 03:11:04,162 --> 03:11:09,300 OTHER WAYS TO GET AROUND THIS 5109 03:11:09,300 --> 03:11:11,035 CONUNDRUM. 5110 03:11:11,035 --> 03:11:13,671 >> Jim: SO, LET ME ASK ANOTHER 5111 03:11:13,671 --> 03:11:14,105 QUESTION. 5112 03:11:14,105 --> 03:11:18,109 AND THAT IS, YOU MENTIONED 5113 03:11:18,109 --> 03:11:19,110 DIFFUSION MRI. 5114 03:11:19,110 --> 03:11:21,045 HOW EARLY DO YOU THINK THAT CAN 5115 03:11:21,045 --> 03:11:23,447 ACTUALLY REALISTICALLY BE 5116 03:11:23,447 --> 03:11:26,384 DEPLOYED IN NEONATES? 5117 03:11:26,384 --> 03:11:28,953 >> YEAH, THAT'S ANOTHER 5118 03:11:28,953 --> 03:11:29,821 FANTASTIC QUESTION. 5119 03:11:29,821 --> 03:11:31,455 WE'VE DONE SOME IMAGING EARLIER 5120 03:11:31,455 --> 03:11:34,058 IN BABIES AND OTHER GROUPS SUCH 5121 03:11:34,058 --> 03:11:36,627 AS FROM AUSTRALIA AND THE U.S. 5122 03:11:36,627 --> 03:11:39,964 AND THE U.K. AND PEOPLE ARE 5123 03:11:39,964 --> 03:11:41,465 TRYING TO GET EARLIER AND 5124 03:11:41,465 --> 03:11:43,401 EARLIER WITH THEIR DIAGNOSIS 5125 03:11:43,401 --> 03:11:45,036 BECAUSE OF COURSE INTERVENTION, 5126 03:11:45,036 --> 03:11:47,071 EARLIER INTERVENTION COULD MEAN 5127 03:11:47,071 --> 03:11:48,406 PREVENTION OF CP ALL TOGETHER OR 5128 03:11:48,406 --> 03:11:51,042 AT A MINIMUM REDUCING A SEVERITY 5129 03:11:51,042 --> 03:11:52,109 OF CEREBRAL PALSY. 5130 03:11:52,109 --> 03:11:55,446 SO THERE'S SOME REALLY GOOD DATA 5131 03:11:55,446 --> 03:11:57,081 FROM 32 WEEKS AND INCREASINGLY, 5132 03:11:57,081 --> 03:12:03,221 THE DATA IS COMING OUT 6 OUT OF 5133 03:12:03,221 --> 03:12:04,388 AUSTRALIA NOW THAT YOU COULD 5134 03:12:04,388 --> 03:12:06,157 DETECT INJURY AT 32 WEEKS AS 5135 03:12:06,157 --> 03:12:06,457 WELL. 5136 03:12:06,457 --> 03:12:07,925 I THINK SOME OF THESE BABIES 5137 03:12:07,925 --> 03:12:11,028 THAT ARE UNDER OUR CARE, 5138 03:12:11,028 --> 03:12:12,663 SUFFERING INJURY EVEN BEYOND 32 5139 03:12:12,663 --> 03:12:15,066 WEEKS SO I THINK THE OVER ALL 5140 03:12:15,066 --> 03:12:16,467 SENSITIVITY WILL BE HIGHER AT 40 5141 03:12:16,467 --> 03:12:18,469 WEEKS BUT THEN YOU LOSE THOSE 5142 03:12:18,469 --> 03:12:20,238 EIGHT WEEKS OF MATURATION AND 5143 03:12:20,238 --> 03:12:21,572 NEURO PLASTICITY SO IF YOU ARE 5144 03:12:21,572 --> 03:12:24,775 REALLY WANTING TO GET IN THERE 5145 03:12:24,775 --> 03:12:26,043 EARLY, SOME OF THESE BABIES WILL 5146 03:12:26,043 --> 03:12:29,680 SHOW THE ABNORMALITIES BEFORE 32 5147 03:12:29,680 --> 03:12:30,314 WEEKS PERHAPS. 5148 03:12:30,314 --> 03:12:34,652 BUT AT LEAST BY 32 WEEKS. 5149 03:12:34,652 --> 03:12:34,852 MANY. 5150 03:12:34,852 --> 03:12:35,219 >> Jim: GREAT. 5151 03:12:35,219 --> 03:12:35,820 THANK YOU. 5152 03:12:35,820 --> 03:12:37,855 SO, LET ME BACK UP. 5153 03:12:37,855 --> 03:12:38,923 RACHEL, LET ME ASK YOU A 5154 03:12:38,923 --> 03:12:42,660 QUESTION IF I CAN. 5155 03:12:42,660 --> 03:12:44,762 ARE THERE WAYS THAT YOU CAN 5156 03:12:44,762 --> 03:12:47,164 SUGGEST THAT RESEARCHERS CONNECT 5157 03:12:47,164 --> 03:12:49,100 WITH STAKEHOLDERS AND ADVOCATES 5158 03:12:49,100 --> 03:12:50,635 ACROSS THE COUNTRY? 5159 03:12:50,635 --> 03:12:53,537 IS THERE A PLACE WHERE 5160 03:12:53,537 --> 03:12:54,772 RESEARCHERS CAN ACTUALLY CONNECT 5161 03:12:54,772 --> 03:12:59,410 WITH STAKEHOLDERS AND EXPRESS 5162 03:12:59,410 --> 03:13:01,045 THEIR WILLINGNESS TO BE PART OF 5163 03:13:01,045 --> 03:13:01,846 RESEARCH TEAMS? 5164 03:13:01,846 --> 03:13:03,180 >> YEAH, ABSOLUTELY. 5165 03:13:03,180 --> 03:13:06,083 AND SON JUST TO PROMOTE THE 5166 03:13:06,083 --> 03:13:07,084 CEREBRAL PALSY FOUNDATION BUT 5167 03:13:07,084 --> 03:13:13,057 OBVIOUSLY IT'S A HUGE PRIORITY 5168 03:13:13,057 --> 03:13:13,391 AREA. 5169 03:13:13,391 --> 03:13:14,959 TO MAKE SURE RESEARCHERS CAN 5170 03:13:14,959 --> 03:13:16,627 COME WITH PROJECTS IN THE LAST 5171 03:13:16,627 --> 03:13:20,331 COUPLE OF YEARS AND PURELY FOR 5172 03:13:20,331 --> 03:13:22,600 THAT PURPOSE AND OBVIOUSLY THERE 5173 03:13:22,600 --> 03:13:25,169 WAS A LITTLE BIT OF WORK ON OUR 5174 03:13:25,169 --> 03:13:26,938 COLLABORATIONS TOGETHER BOTH 5175 03:13:26,938 --> 03:13:28,239 THROUGH THE EARLY DETECTION 5176 03:13:28,239 --> 03:13:29,774 NETWORK AND OTHER PIECES. 5177 03:13:29,774 --> 03:13:31,909 THE EXCITING OPPORTUNITY HERE 5178 03:13:31,909 --> 03:13:33,110 THOUGH IS THAT THE COMMUNITY 5179 03:13:33,110 --> 03:13:35,513 WANTS TO BE INVOLVED. 5180 03:13:35,513 --> 03:13:38,783 WE HAVE A VERY ENGAGE COMMUNITY 5181 03:13:38,783 --> 03:13:40,318 BOTH INDIVIDUALS WITH CEREBRAL 5182 03:13:40,318 --> 03:13:41,719 PALSY AND THEIR FAMILIES AND 5183 03:13:41,719 --> 03:13:43,054 THEY DO WANT TO BE INVOLVED SO 5184 03:13:43,054 --> 03:13:45,289 WE HIGHLY RECOMMEND FOR 5185 03:13:45,289 --> 03:13:46,590 RESEARCHERS TO REACH OUT TO 5186 03:13:46,590 --> 03:13:47,391 STAKEHOLDER GROUPS WHETHER IT'S 5187 03:13:47,391 --> 03:13:48,459 THE CEREBRAL PALSY FOUNDATION OR 5188 03:13:48,459 --> 03:13:49,660 WHETHER IT'S CEREBRAL PALSY 5189 03:13:49,660 --> 03:13:51,629 RESEARCH NETWORK. 5190 03:13:51,629 --> 03:13:53,431 WE NOW HAVE THE INFRASTRUCTURE 5191 03:13:53,431 --> 03:13:55,900 IN PLACE TO BE ABLE TO HELP TO 5192 03:13:55,900 --> 03:13:58,669 RECRUIT TO THESE STUDIES AND THE 5193 03:13:58,669 --> 03:14:00,338 OTHER PIECES TO THINK ABOUT IS 5194 03:14:00,338 --> 03:14:06,243 WHAT DOES THE METH MYTHOLOGY LOK 5195 03:14:06,243 --> 03:14:09,313 LIKE SO WE CAN ENSURE THAT BOTH 5196 03:14:09,313 --> 03:14:11,649 THE STUDY ITSELF IS WHAT THE 5197 03:14:11,649 --> 03:14:13,184 COMMUNITY WANTS BUT ALSO THE 5198 03:14:13,184 --> 03:14:14,251 OUTCOME MEASURES AS WELL BUT 5199 03:14:14,251 --> 03:14:15,619 YEAH, I WOULD HIGHLY RECOMMEND 5200 03:14:15,619 --> 03:14:17,188 TO REACH OUT TO THE FOUNDATION 5201 03:14:17,188 --> 03:14:19,123 OR REACH OUT TO SEVERAL RESEARCH 5202 03:14:19,123 --> 03:14:20,558 NETWORKS AND WE ARE BOTH HIGHLY 5203 03:14:20,558 --> 03:14:23,527 ENGAGE IN THOSE ACTIVITIES. 5204 03:14:23,527 --> 03:14:24,195 >> GREAT. 5205 03:14:24,195 --> 03:14:25,463 THANK YOU. 5206 03:14:25,463 --> 03:14:26,764 I KNOW THERE WAS A FAIR NUMBER 5207 03:14:26,764 --> 03:14:28,532 OF COMMENTS IN THE QUESTION AND 5208 03:14:28,532 --> 03:14:29,967 ANSWER ABOUT HOW PEOPLE CAN GET 5209 03:14:29,967 --> 03:14:32,069 INVOLVED SO I THINK THAT THAT 5210 03:14:32,069 --> 03:14:32,737 WAS GREAT. 5211 03:14:32,737 --> 03:14:35,206 >> AND FOR THE COMMUNITY ITSELF, 5212 03:14:35,206 --> 03:14:38,976 WE HAVE A PAGE OR CEREBRAL PALSY 5213 03:14:38,976 --> 03:14:39,477 RESOURCE. 5214 03:14:39,477 --> 03:14:42,380 IT'S SPECIFICALLY FOR CLINICAL 5215 03:14:42,380 --> 03:14:44,181 TRIALS AND RECRUITMENT AND IT 5216 03:14:44,181 --> 03:14:46,050 HAS BOTH STUDIES BROKEN DOWN BY 5217 03:14:46,050 --> 03:14:47,818 AGE AS WELL AS GEOGRAPHICAL 5218 03:14:47,818 --> 03:14:48,986 REGIONS SO FOR ANY OF THE 5219 03:14:48,986 --> 03:14:50,321 COMMUNITY MEMBERS WHO WANT TO GO 5220 03:14:50,321 --> 03:14:51,389 HAVE A LOOK AT THAT. 5221 03:14:51,389 --> 03:14:58,095 IT HAS IT AUTOM ALL BROKE UNDOW. 5222 03:14:58,095 --> 03:14:59,330 >> Jim: TERRIFIC, THANK YOU. 5223 03:14:59,330 --> 03:15:01,298 KATHY, A QUICK QUESTION FOR YOU. 5224 03:15:01,298 --> 03:15:03,901 YOU TALKED A LOT ABOUT SEROTONIN 5225 03:15:03,901 --> 03:15:06,404 AND VOLUME TRANSMISSION AND ITS 5226 03:15:06,404 --> 03:15:09,640 DEVELOPMENT, AND POTENTIAL USE 5227 03:15:09,640 --> 03:15:12,009 AS A THERAPEUTIC. 5228 03:15:12,009 --> 03:15:14,545 SEROTONIN IS PRETTY WIDELY 5229 03:15:14,545 --> 03:15:16,313 EXPRESSED THROUGHOUT THE BRAIN 5230 03:15:16,313 --> 03:15:19,583 AND THE GUT AND A LOT OF OTHER 5231 03:15:19,583 --> 03:15:21,986 PLACE, HOW DO YOU THINK THAT YOU 5232 03:15:21,986 --> 03:15:25,156 COULD TARGET AN INTERVENTION 5233 03:15:25,156 --> 03:15:26,257 SPECIFICALLY ENOUGH IS THAT IT 5234 03:15:26,257 --> 03:15:29,026 WOULD NOT HAVE A LOT OF SIDE 5235 03:15:29,026 --> 03:15:30,461 EFFECTS AND MIGHT BE BENEFICIAL 5236 03:15:30,461 --> 03:15:31,562 IN CP? 5237 03:15:31,562 --> 03:15:33,697 >> IT'S A GREAT QUESTION. 5238 03:15:33,697 --> 03:15:35,633 AND THE SHORT ANSWER IS THAT WE 5239 03:15:35,633 --> 03:15:37,568 HAVE A LOT OF WORK YET TO DO IN 5240 03:15:37,568 --> 03:15:38,936 ORDER TO BE ABLE TO ANSWER THAT 5241 03:15:38,936 --> 03:15:41,405 AND HOPEFULLY BY TARGETING THE 5242 03:15:41,405 --> 03:15:44,375 SPECIFIC RECEPTORS SUBTYPE, AND 5243 03:15:44,375 --> 03:15:46,510 THE SPECIFIC TIMING AT WHICH IT 5244 03:15:46,510 --> 03:15:50,981 WOULD BE EFFECTIVE AT REDUCING 5245 03:15:50,981 --> 03:15:53,517 HYPER TONIA OR SASS SIS TEE, IT 5246 03:15:53,517 --> 03:15:58,155 COULD HELP TARGET IT TO THE 5247 03:15:58,155 --> 03:16:08,466 LOCATION AS WELL. 5248 03:16:22,113 --> 03:16:26,951 >> POTENTIALLY THE RECEPTORS IS 5249 03:16:26,951 --> 03:16:28,252 EXPRESSED IN OTHER AREAS BESIDES 5250 03:16:28,252 --> 03:16:29,887 THE SPINAL CORD. 5251 03:16:29,887 --> 03:16:33,190 THERE ARE 5HT2A RE SCEPTER AND 5252 03:16:33,190 --> 03:16:34,625 DEVELOPING MUSCLE FIBERS AND 5253 03:16:34,625 --> 03:16:36,360 SATELLITE CELLS FOR EXAMPLE. 5254 03:16:36,360 --> 03:16:39,797 FIRST OF ALL, THE DEVELOPING 5255 03:16:39,797 --> 03:16:42,032 MUSCLES MAY ALSO BE EXPOSED TO 5256 03:16:42,032 --> 03:16:44,034 INCREASE SEROTONIN THAT HASN'T 5257 03:16:44,034 --> 03:16:46,237 BEEN DEMONSTRATED WHETHER THEY 5258 03:16:46,237 --> 03:16:47,138 HAVE OR NOT. 5259 03:16:47,138 --> 03:16:49,573 I AM INTERESTED IN LOOKING MORE 5260 03:16:49,573 --> 03:16:52,309 BROADLY AT THE DEVELOPING MOTOR 5261 03:16:52,309 --> 03:16:55,012 UNIT AND TO TRY TO DISCERN 5262 03:16:55,012 --> 03:17:02,386 WHETHER IT'S NEEDED IN THE 5263 03:17:02,386 --> 03:17:04,121 CENTRAL NERVOUS SYSTEM MORE 5264 03:17:04,121 --> 03:17:05,489 GLOBALLY AND THAT'S ANOTHER KEY 5265 03:17:05,489 --> 03:17:05,923 QUESTION. 5266 03:17:05,923 --> 03:17:11,829 IT'S POSSIBLE THAT IT COULD BE 5267 03:17:11,829 --> 03:17:13,130 APPLIED ONCE IF IT'S ONLY NEEDED 5268 03:17:13,130 --> 03:17:14,832 IN THE CENTRAL NERVOUS SYSTEM 5269 03:17:14,832 --> 03:17:15,800 BUT THAT'S SEVERAL STEPS DOWN 5270 03:17:15,800 --> 03:17:19,470 THE ROAD AND I DON'T KNOW THOSE 5271 03:17:19,470 --> 03:17:20,471 ANSWERS YET. 5272 03:17:20,471 --> 03:17:24,308 >> Jim: SO, BETWEEN YOU AND 5273 03:17:24,308 --> 03:17:27,178 BERNADETTE AND ACTUALLY NATALIE 5274 03:17:27,178 --> 03:17:29,213 ALSO, IS THERE ANY INDICATION 5275 03:17:29,213 --> 03:17:32,049 THAT NEURO MODULATION, OR THE 5276 03:17:32,049 --> 03:17:33,951 SENSORY MOTOR STIMULATION THAT 5277 03:17:33,951 --> 03:17:36,353 NATALIE WAS TALKING ABOUT, MIGHT 5278 03:17:36,353 --> 03:17:39,757 ACTUALLY IMPACT ON THE 5279 03:17:39,757 --> 03:17:41,759 DEVELOPMENT OF THE SYSTEM. 5280 03:17:41,759 --> 03:17:44,595 IS THAT ONE WAY THAT THESE 5281 03:17:44,595 --> 03:17:45,629 PARTICULAR INTERVENTIONS COULD 5282 03:17:45,629 --> 03:17:46,363 BE WORKING? 5283 03:17:46,363 --> 03:17:48,866 >> I WOULD GUESS, ABSOLUTELY 5284 03:17:48,866 --> 03:17:49,033 YES. 5285 03:17:49,033 --> 03:17:51,936 I'VE HAD SOME INTERESTING 5286 03:17:51,936 --> 03:17:53,003 CONVERSATIONS WITH NATALIE ABOUT 5287 03:17:53,003 --> 03:17:55,439 THE SAME TOPIC AND I ABSOLUTELY 5288 03:17:55,439 --> 03:17:56,006 THINK SO. 5289 03:17:56,006 --> 03:17:59,176 I THINK THAT THE -- IT'S BEEN 5290 03:17:59,176 --> 03:18:01,478 DEMONSTRATED THAT RECEPTORS HAVE 5291 03:18:01,478 --> 03:18:04,014 A LOT OF IMPORTANCE IN SENSORY 5292 03:18:04,014 --> 03:18:06,684 AND PAIN PROCESSING PATHWAYS AND 5293 03:18:06,684 --> 03:18:09,053 THESE ARE EXTREMELY IMPORTANT IN 5294 03:18:09,053 --> 03:18:09,653 CEREBRAL PALSY. 5295 03:18:09,653 --> 03:18:12,690 >> I WOULD SAY ALSO, ON 5296 03:18:12,690 --> 03:18:15,326 PIGGYBACKING ON THAT, WE CAN 5297 03:18:15,326 --> 03:18:16,961 MEASURE CENTRAL AND PERIPHERAL 5298 03:18:16,961 --> 03:18:18,963 TIMES AND START TO UNDERSTAND 5299 03:18:18,963 --> 03:18:21,699 FURTHER WHAT IS HAPPENING FROM A 5300 03:18:21,699 --> 03:18:23,300 NEUROPHYSIOLOGICAL AND NEURO AN 5301 03:18:23,300 --> 03:18:25,603 ATOMIC PERSPECTIVE SO IT'S A 5302 03:18:25,603 --> 03:18:27,338 GREAT OPPORTUNITY AND TO USE 5303 03:18:27,338 --> 03:18:30,808 MODELING AS WELL TO DO THAT. 5304 03:18:30,808 --> 03:18:32,276 >> I AGREE. 5305 03:18:32,276 --> 03:18:35,012 THE OTHER THING IS THAT SOME OF 5306 03:18:35,012 --> 03:18:37,147 THESE SYSTEMS AFFECT THE LARGER 5307 03:18:37,147 --> 03:18:37,648 PICTURE, RIGHT. 5308 03:18:37,648 --> 03:18:39,183 IF YOU THINK ABOUT THE 5309 03:18:39,183 --> 03:18:40,918 INTERNATIONAL CLASSIFICATION OF 5310 03:18:40,918 --> 03:18:42,586 FUNCTION, YOU ARE ALSO TALKING 5311 03:18:42,586 --> 03:18:45,422 ABOUT SEROTONINS' IMPACT NOT 5312 03:18:45,422 --> 03:18:47,858 JUST FOR SENSORY MOTOR PROCESSES 5313 03:18:47,858 --> 03:18:50,694 IN CEREBRAL PALSY BUT ALSO IN 5314 03:18:50,694 --> 03:18:55,866 LEARNING ITSELF AND HOW EMOTION 5315 03:18:55,866 --> 03:18:57,301 AND CONNECTION ALSO FOSTER 5316 03:18:57,301 --> 03:18:58,469 LEARNING. 5317 03:18:58,469 --> 03:19:00,704 SO IT'S REALLY COMPLEX AND I 5318 03:19:00,704 --> 03:19:02,506 ACTUALLY THINK THAT THIS IS 5319 03:19:02,506 --> 03:19:04,308 CRITICAL WORK IN UNDERSTANDING 5320 03:19:04,308 --> 03:19:06,877 MORE THAN SIMPLY META SENSORY 5321 03:19:06,877 --> 03:19:09,480 AND MOTOR PROCESSES BUT 5322 03:19:09,480 --> 03:19:10,648 EVERYTHING ELSE THAT GOES WITH 5323 03:19:10,648 --> 03:19:14,451 FUNCTION AND CP. 5324 03:19:14,451 --> 03:19:17,921 >> TAKING OFF FROM WHAT YOU JUST 5325 03:19:17,921 --> 03:19:19,323 SAID AND THINKING ABOUT WHAT 5326 03:19:19,323 --> 03:19:22,960 MICHAEL SAID ABOUT THE N OF 1, 5327 03:19:22,960 --> 03:19:25,229 CLINICAL TRIALS AND THEIR 5328 03:19:25,229 --> 03:19:27,364 IMPORTANCE, ARE SOME OF THE 5329 03:19:27,364 --> 03:19:30,434 NEURO MODULATORY AND SENSORY 5330 03:19:30,434 --> 03:19:33,637 MOTOR INTERVENTIONS POTENTIALLY 5331 03:19:33,637 --> 03:19:37,775 USEFUL IN THE N OF 1 CONTEXT AND 5332 03:19:37,775 --> 03:19:40,277 IS THERE A WAY TO TIE THE 5333 03:19:40,277 --> 03:19:42,513 GENETICS TOGETHER WITH SOME OF 5334 03:19:42,513 --> 03:19:45,115 THE NEURO MODULATION ATTEMPTS? 5335 03:19:45,115 --> 03:19:46,183 >> YES. 5336 03:19:46,183 --> 03:19:48,085 I'M GOING TO SAY I'M GOING TO 5337 03:19:48,085 --> 03:19:55,826 SPEAK FOR AUTOMA ALL OF US ON TL 5338 03:19:55,826 --> 03:19:56,627 AND THAT -- 5339 03:19:56,627 --> 03:19:57,461 >> Jim: O. WELL, THAT WAS KIND 5340 03:19:57,461 --> 03:20:00,531 OF AN OPEN-ENDED QUESTION, I 5341 03:20:00,531 --> 03:20:02,433 GUESS. 5342 03:20:02,433 --> 03:20:04,468 SO, BERNADETTE, LET ME ASK YOU 5343 03:20:04,468 --> 03:20:05,235 ANOTHER QUESTION. 5344 03:20:05,235 --> 03:20:07,237 THANK YOU FOR TAKING US THROUGH 5345 03:20:07,237 --> 03:20:10,074 ALL THE NEURO MODULATORY 5346 03:20:10,074 --> 03:20:16,113 STRATEGIES LIKE DCS AND TM S AND 5347 03:20:16,113 --> 03:20:19,783 VAGAL NERVE STIMULATION BUT THEY 5348 03:20:19,783 --> 03:20:24,755 HAVE RATHER BREWED DIFFUSE DIFF- 5349 03:20:24,755 --> 03:20:27,091 IS THERE A POSSIBILITY OF THE 5350 03:20:27,091 --> 03:20:29,226 DEVELOPING BRAIN AND MAYBE EVEN 5351 03:20:29,226 --> 03:20:30,227 MALL ADAPTIVE EFFECTS. 5352 03:20:30,227 --> 03:20:30,994 >> ABSOLUTELY. 5353 03:20:30,994 --> 03:20:35,265 WHAT I DIDN'T SPEND THE TIME ON 5354 03:20:35,265 --> 03:20:40,671 IS OUR MODELING. 5355 03:20:40,671 --> 03:20:42,439 IT'S TOO GENERAL AND TOO DIFFUSE 5356 03:20:42,439 --> 03:20:44,408 IN TERMS OF SPECIFIC TARGETED 5357 03:20:44,408 --> 03:20:45,943 ACTIVITIES SO, IT'S AN AREA THAT 5358 03:20:45,943 --> 03:20:47,344 WE NEED TO IMPROVE UPON AND WHEN 5359 03:20:47,344 --> 03:20:51,548 YOU ARE ASKING THAT QUESTION, OF 5360 03:20:51,548 --> 03:20:53,917 Dr. QUINLAN AND Dr. MAITRE, 5361 03:20:53,917 --> 03:20:57,521 I WAS THINKING, HOW DO WE BECOME 5362 03:20:57,521 --> 03:20:59,990 MORE SPECIFIC IN OUR TARGETS. 5363 03:20:59,990 --> 03:21:03,160 JUST AS THAT IS WHY I MENTIONED 5364 03:21:03,160 --> 03:21:04,795 THE MALL ADAPTIVE PLASTICITY AND 5365 03:21:04,795 --> 03:21:06,096 RESEARCH AT THIS LEVEL TAKES A 5366 03:21:06,096 --> 03:21:09,433 LOT OF RIGGER AND IT SHOULD AND 5367 03:21:09,433 --> 03:21:11,435 WE SHOULD BE STEWARDS FOR THE 5368 03:21:11,435 --> 03:21:12,436 SAFETY FOR THE INDIVIDUALS WHO 5369 03:21:12,436 --> 03:21:14,471 WE SERVE AND SO IT'S REALLY A 5370 03:21:14,471 --> 03:21:18,208 GREAT QUESTION IN TERMS OF 5371 03:21:18,208 --> 03:21:20,544 CONTINUING THAT LINE AND IT'S 5372 03:21:20,544 --> 03:21:24,214 REALLY IMPORTANT AND I LOVED 5373 03:21:24,214 --> 03:21:25,382 THAT COMMENT BECAUSE LOOKING AT 5374 03:21:25,382 --> 03:21:26,717 EACH ONE OF THOSE INDIVIDUAL 5375 03:21:26,717 --> 03:21:30,487 CASES ALLOWS US, IT'S 100% MORE 5376 03:21:30,487 --> 03:21:31,555 THAN WE HAD WHEN WE DIDN'T HAVE 5377 03:21:31,555 --> 03:21:33,924 ANYONE SO WHEN WE PUT IT 5378 03:21:33,924 --> 03:21:36,360 TOGETHER IT TELLS A STORY OF 5379 03:21:36,360 --> 03:21:37,327 SAFETY, FEASIBILITY AND THEN 5380 03:21:37,327 --> 03:21:44,168 EFFICACY WHICH IS REALLY 5381 03:21:44,168 --> 03:21:46,904 IMPORTANT. 5382 03:21:46,904 --> 03:21:47,337 >> Jim: THANK YOU. 5383 03:21:47,337 --> 03:21:49,840 SO, MICHAEL, LET ME COME BACK 5384 03:21:49,840 --> 03:21:53,510 AND ASK YOU ANOTHER QUESTION. 5385 03:21:53,510 --> 03:21:56,246 ONE OF THE THINGS THAT WE KNOW 5386 03:21:56,246 --> 03:21:57,414 ABOUT CEREBRAL PALSY IS IT'S 5387 03:21:57,414 --> 03:22:00,851 VERY, VERY HETEROGENEOUS 5388 03:22:00,851 --> 03:22:06,056 DISORDER AND I'M CURIOUS IN YOUR 5389 03:22:06,056 --> 03:22:09,993 STUDIES, HOW DO YOU USE THAT TO 5390 03:22:09,993 --> 03:22:11,462 YOUR ADVANTAGE? 5391 03:22:11,462 --> 03:22:13,797 DO YOU HAVE TO DO REALLY SOME 5392 03:22:13,797 --> 03:22:15,232 VERY STRONG PHENOTYPING TO BE 5393 03:22:15,232 --> 03:22:17,801 ABLE TO MAKE THE GENETICS WORK 5394 03:22:17,801 --> 03:22:21,772 OR CAN YOU USE THE HETEROGENEITY 5395 03:22:21,772 --> 03:22:23,574 OF CEREBRAL PALSY AS A WAY TO 5396 03:22:23,574 --> 03:22:28,011 EXPAND SOME OF YOUR GENOMICS? 5397 03:22:28,011 --> 03:22:30,414 >> THANK YOU FOR THE QUESTION. 5398 03:22:30,414 --> 03:22:35,319 I THINK THAT IT GOES BOTH WAYS. 5399 03:22:35,319 --> 03:22:37,321 SO THAT THE LIMITED CLINICAL 5400 03:22:37,321 --> 03:22:39,089 INFORMATION WE CAN STILL 5401 03:22:39,089 --> 03:22:39,890 SOMETIMES DERIVE SOME IMPORTANT 5402 03:22:39,890 --> 03:22:43,794 FINDINGS FROM THE GENETICS. 5403 03:22:43,794 --> 03:22:45,195 I'M OFTEN FOND OF SAYING THAT 5404 03:22:45,195 --> 03:22:47,931 THE GENOMICS ARE REALLY ONLY ONE 5405 03:22:47,931 --> 03:22:49,299 SIDE OF THE COIN AND IF WE 5406 03:22:49,299 --> 03:22:54,571 QUOTE-UNQUOTE DISCOVER A NEW 5407 03:22:54,571 --> 03:22:54,972 GENE, 5408 03:22:54,972 --> 03:22:56,707 WHAT DID WE JUST DISCOVER? 5409 03:22:56,707 --> 03:22:58,375 THE CLINICAL PHENOTYPES AND I 5410 03:22:58,375 --> 03:23:00,143 MEAN THAT VERY BROADLY. 5411 03:23:00,143 --> 03:23:01,778 NOT ONLY LOOKING AT MOVEMENT 5412 03:23:01,778 --> 03:23:03,680 DISORDERS BUT LOOKING AT NEURO 5413 03:23:03,680 --> 03:23:05,949 AND PHYSIOLOGY AND NEUROIMAGING 5414 03:23:05,949 --> 03:23:10,454 AND LOOKING AT INDIVIDUALS WITH 5415 03:23:10,454 --> 03:23:11,788 CEREBRAL PALSY AT A DEEP LEVEL, 5416 03:23:11,788 --> 03:23:14,525 I THINK REPRESENTS A TREMENDOUS 5417 03:23:14,525 --> 03:23:17,828 OPPORTUNITY BECAUSE AS WE ALL 5418 03:23:17,828 --> 03:23:19,363 KNOW, THERE IS A LOT OF 5419 03:23:19,363 --> 03:23:23,967 VARIABILITY IN TERMS OF THE 5420 03:23:23,967 --> 03:23:25,135 POPULATION OF PEOPLE LIVING WITH 5421 03:23:25,135 --> 03:23:25,736 CEREBRAL PALSY. 5422 03:23:25,736 --> 03:23:31,241 OVER TIME, WE ACTUALLY HAVE A 5423 03:23:31,241 --> 03:23:32,276 GREAT OPPORTUNITY AT THIS POINT 5424 03:23:32,276 --> 03:23:34,545 AND OVER TIME, WE'RE GOING TO BE 5425 03:23:34,545 --> 03:23:37,848 ABLE TO DO MORE KIND OF 5426 03:23:37,848 --> 03:23:39,016 PRECISION GENOMICS AND WE'LL 5427 03:23:39,016 --> 03:23:43,754 LOOK AT MORE DEEPLY INTO THE 5428 03:23:43,754 --> 03:23:45,522 CHARACTERISTICS OF AN INDIVIDUAL 5429 03:23:45,522 --> 03:23:45,889 CEREBRAL PALSY. 5430 03:23:45,889 --> 03:23:48,158 WE'LL BE ABLE TO DEFINE THAT AT 5431 03:23:48,158 --> 03:23:49,326 MULTIPLE LEVELS AND NOT JUST 5432 03:23:49,326 --> 03:23:52,863 WHAT WE SEE CLINICALLY, BUT WHAT 5433 03:23:52,863 --> 03:23:55,098 IS HAPPENING IN THE BRAIN AT A 5434 03:23:55,098 --> 03:23:58,135 STRUCTURAL LEVEL AND A 5435 03:23:58,135 --> 03:23:59,570 FUNCTIONAL LEVEL, DOWN TO THE 5436 03:23:59,570 --> 03:24:00,037 SPINAL CORD. 5437 03:24:00,037 --> 03:24:01,271 ALL THE OF THE THINGS THAT 5438 03:24:01,271 --> 03:24:03,173 YOU'VE HEARD ABOUT THIS MORNING, 5439 03:24:03,173 --> 03:24:04,841 I THINK REALLY CAN BE INTEGRATED 5440 03:24:04,841 --> 03:24:08,812 AND I THINK GENOMICS IS ONE TOOL 5441 03:24:08,812 --> 03:24:11,548 TO HELP TO DO THAT BUT MY HOPE 5442 03:24:11,548 --> 03:24:15,052 IS THAT WITH THE APPLICATION OF 5443 03:24:15,052 --> 03:24:17,554 MORE AND MORE PRECISE FEN OWE 5444 03:24:17,554 --> 03:24:18,956 TYPING IT WILL DRIVE OUTCOMES 5445 03:24:18,956 --> 03:24:20,123 RESEARCH OVER TIME AND IT WILL 5446 03:24:20,123 --> 03:24:24,227 BE ABLE TO SOMETIMES -- IF YOU 5447 03:24:24,227 --> 03:24:25,696 LOOK AT THREE INDIVIDUALS AND 5448 03:24:25,696 --> 03:24:26,930 ONE RESPONDS TO INTERSECTION AND 5449 03:24:26,930 --> 03:24:28,165 ONE RESPONDS NOT AT ALL AND ONE 5450 03:24:28,165 --> 03:24:29,900 RESPONDS IN THE MIDDLE, WELL THE 5451 03:24:29,900 --> 03:24:32,135 NET OF THAT IS REALLY NO 5452 03:24:32,135 --> 03:24:34,371 DIFFERENCE FROM A CONTROL GROUP. 5453 03:24:34,371 --> 03:24:35,706 PERHAPS, THERE MIGHT BE 5454 03:24:35,706 --> 03:24:37,841 DIFFERENCES IN TRYING TO LOOK AT 5455 03:24:37,841 --> 03:24:40,043 INDO PHENOTYPES OR SPECIFIC 5456 03:24:40,043 --> 03:24:41,411 CLINICAL DIFFERENCES THAT MIGHT 5457 03:24:41,411 --> 03:24:46,984 DRIVE DIFFERENCES IN RESPONSE. 5458 03:24:46,984 --> 03:24:47,351 >> Jim: GREAT. 5459 03:24:47,351 --> 03:24:48,118 THANK YOU. 5460 03:24:48,118 --> 03:24:50,187 SO, NATALIE, LET ME COME BACK TO 5461 03:24:50,187 --> 03:24:51,888 YOU WITH A FOLLOW-UP QUESTION. 5462 03:24:51,888 --> 03:24:53,657 IF I CAN. 5463 03:24:53,657 --> 03:24:56,994 AND IN YOUR APPLES' STUDY, YOU 5464 03:24:56,994 --> 03:24:58,895 TALKED ABOUT RECRUITING A VERY 5465 03:24:58,895 --> 03:25:00,897 DIVERSE SUBJECT POPULATION. 5466 03:25:00,897 --> 03:25:03,767 COULD YOU SHARE WITH US LITTLE 5467 03:25:03,767 --> 03:25:05,168 BIT MORE ABOUT YOUR STRATEGIES 5468 03:25:05,168 --> 03:25:07,204 TO ENHANCE DIVERSITY AND THE WAY 5469 03:25:07,204 --> 03:25:08,672 THAT YOU'VE RECRUITED FOLKS INTO 5470 03:25:08,672 --> 03:25:09,506 YOUR STUDY? 5471 03:25:09,506 --> 03:25:11,541 >> SURE, WHEN I FIRST STARTED, 5472 03:25:11,541 --> 03:25:13,276 AND IT PLAYS INTO EVERYTHING 5473 03:25:13,276 --> 03:25:15,045 OTHER PEOPLE HAVE TALKED ABOUT, 5474 03:25:15,045 --> 03:25:15,245 RIGHT. 5475 03:25:15,245 --> 03:25:17,514 YOU ARE TALKING ABOUT GENETIC 5476 03:25:17,514 --> 03:25:19,916 MAKE UP, ABOUT GENOMICS BUT IF 5477 03:25:19,916 --> 03:25:20,817 YOU ARE GOING TO GET RESULTS 5478 03:25:20,817 --> 03:25:22,486 THAT ARE GOING TO MATTER, YOU 5479 03:25:22,486 --> 03:25:26,023 NEED TO HAVE A WIDE DIVERSITY OF 5480 03:25:26,023 --> 03:25:26,289 PATIENTS. 5481 03:25:26,289 --> 03:25:29,059 SO IT REALLY TIES IN WELL TO 5482 03:25:29,059 --> 03:25:29,893 THAT. 5483 03:25:29,893 --> 03:25:33,296 SO, THE NIH HAS ON MANY OF THE 5484 03:25:33,296 --> 03:25:34,331 APPLICATIONS SOMETHING THAT'S 5485 03:25:34,331 --> 03:25:35,899 CALLED PDPE, I DON'T KNOW IF YOU 5486 03:25:35,899 --> 03:25:37,301 HAVE HEARD ABOUT IT. 5487 03:25:37,301 --> 03:25:39,303 SO A PLAN FOR ENHANCING DIVERSE 5488 03:25:39,303 --> 03:25:41,304 PERSPECTIVES AND RESEARCH AND 5489 03:25:41,304 --> 03:25:45,308 ANYWAY, WE TOOK IT PRETTY 5490 03:25:45,308 --> 03:25:46,943 SERIOUSLY. 5491 03:25:46,943 --> 03:25:48,612 AND ONE OF THE WAYS WE FIRST 5492 03:25:48,612 --> 03:25:50,881 ENHANCED DIVERSITY IS BY 5493 03:25:50,881 --> 03:25:52,516 ASSESSING BARRIERS AND FORGIVE 5494 03:25:52,516 --> 03:25:54,985 ME ONE SECOND. 5495 03:25:54,985 --> 03:25:58,622 WHAT ARE THE SOCIAL DETERMINANTS 5496 03:25:58,622 --> 03:26:02,259 OF HEALTH THAT COULD BE PLAYING 5497 03:26:02,259 --> 03:26:04,961 INTO NOT JUST PEOPLE'S RESPONSES 5498 03:26:04,961 --> 03:26:06,263 TO HAVING A CHILD WITH CEREBRAL 5499 03:26:06,263 --> 03:26:07,564 PALSY OR HIGH -RISK FOR CEREBRAL 5500 03:26:07,564 --> 03:26:09,099 PALSY BECAUSE WE START, YOU 5501 03:26:09,099 --> 03:26:10,167 KNOW, THERE'S A QUESTION ABOUT 5502 03:26:10,167 --> 03:26:12,069 STROKE AND WE START YOUNGER WHEN 5503 03:26:12,069 --> 03:26:13,837 THEY'RE HIGH-RISK. 5504 03:26:13,837 --> 03:26:15,338 WHAT ARE THE THINGS THAT PLAY 5505 03:26:15,338 --> 03:26:17,507 INTO THE DEVELOPMENT OF THE 5506 03:26:17,507 --> 03:26:19,409 CONDITIONS TO THEIR ACCESS TO 5507 03:26:19,409 --> 03:26:20,711 HEALTHCARE AND ALSO TO THEIR 5508 03:26:20,711 --> 03:26:22,112 ACCESS TO RESEARCH. 5509 03:26:22,112 --> 03:26:24,514 SO WHEN WE FIGURE OUT -- IT'S 5510 03:26:24,514 --> 03:26:25,682 DIFFERENT FOR EVERYONE, RIGHT. 5511 03:26:25,682 --> 03:26:27,951 IF YOU DON'T SPEND THE TIME, 5512 03:26:27,951 --> 03:26:30,287 ASSESSING IT, WHAT ARE THESE 5513 03:26:30,287 --> 03:26:31,955 SOCIAL -- AND IT'S PSYCHOSOCIAL 5514 03:26:31,955 --> 03:26:34,191 DETERMINANTS OF HEALTH. 5515 03:26:34,191 --> 03:26:39,463 WE ASSESS EVERYTHING FROM ACES 5516 03:26:39,463 --> 03:26:41,898 TO WHAT ARE THE IMPACT OF POST 5517 03:26:41,898 --> 03:26:42,833 TRAUMATIC STRESS DISORDER ON 5518 03:26:42,833 --> 03:26:45,202 THEIR FAMILY AND THINGS LIKE 5519 03:26:45,202 --> 03:26:45,435 THAT. 5520 03:26:45,435 --> 03:26:50,273 SO THAT WHEN THEY DO COME INTO 5521 03:26:50,273 --> 03:26:51,308 RESEARCH, WE KNOW WHERE THEY'RE 5522 03:26:51,308 --> 03:26:52,642 COMING FROM AND WE CAN MEET 5523 03:26:52,642 --> 03:26:53,009 THEM. 5524 03:26:53,009 --> 03:26:54,911 WE ALSO DESIGN OUR RESEARCH 5525 03:26:54,911 --> 03:26:57,013 BASED ON WHAT OUR STAKEHOLDERS 5526 03:26:57,013 --> 03:26:58,115 SAY THEY WANT. 5527 03:26:58,115 --> 03:27:00,350 AND THAT IS WHY IT WORKS, RIGHT. 5528 03:27:00,350 --> 03:27:02,452 WE GET MORE BUY-INTO TO OUR 5529 03:27:02,452 --> 03:27:04,254 RESEARCH BECAUSE PARENTS HELP 5530 03:27:04,254 --> 03:27:05,655 DESIGN EVERYTHING FROM THE 5531 03:27:05,655 --> 03:27:08,058 DESIGN OF THE TRIAL TO THE 5532 03:27:08,058 --> 03:27:10,327 INTERVENTIONS TO THE OUTCOMES 5533 03:27:10,327 --> 03:27:12,362 AND SO THEY FEEL LIKE THEY HAVE 5534 03:27:12,362 --> 03:27:14,831 A BUY IN INTO THE RESEARCH. 5535 03:27:14,831 --> 03:27:17,567 AND THEN THE LAST THING IS YOU 5536 03:27:17,567 --> 03:27:24,408 KNOW, IN ADDITION TO RESEARCH 5537 03:27:24,408 --> 03:27:25,942 THAT MATTERS AND THAT THEY CAN 5538 03:27:25,942 --> 03:27:28,879 DO, WE MAKE THE ENVIRONMENT AS 5539 03:27:28,879 --> 03:27:32,215 CONDUCIVE TO MEETING THEM AS WE 5540 03:27:32,215 --> 03:27:32,682 CAN. 5541 03:27:32,682 --> 03:27:34,684 SO, ALL THE RESEARCHERS THAT ARE 5542 03:27:34,684 --> 03:27:37,420 HERE AND ALSO TOMORROW, HAVE 5543 03:27:37,420 --> 03:27:39,089 LEVERAGED ALL THESE STRATEGIES, 5544 03:27:39,089 --> 03:27:39,389 RIGHT. 5545 03:27:39,389 --> 03:27:43,260 I'M NOT TEACHING ANYONE 5546 03:27:43,260 --> 03:27:43,527 ANYTHING. 5547 03:27:43,527 --> 03:27:45,262 WE HAVE SETTINGS IN WHICH 5548 03:27:45,262 --> 03:27:46,730 NURSING MOTHERS CAN BE BECAUSE 5549 03:27:46,730 --> 03:27:49,099 THEY'RE NURSING ROOMS, CHANGING 5550 03:27:49,099 --> 03:27:50,267 TABLES, THERE ARE KITCHENS, 5551 03:27:50,267 --> 03:27:52,536 THERE ARE ALL THESE THINGS THAT 5552 03:27:52,536 --> 03:27:53,970 MAKE REAL LIFE POSSIBLE AT THE 5553 03:27:53,970 --> 03:27:56,039 SAME TIME AS YOU DO RESEARCH. 5554 03:27:56,039 --> 03:27:58,909 AND WE ALSO HAVE PEOPLE WHO ARE 5555 03:27:58,909 --> 03:27:59,209 SPECIALIZED. 5556 03:27:59,209 --> 03:28:00,410 WHO MAKE SURE THAT WE'RE NOT 5557 03:28:00,410 --> 03:28:04,080 JUST CULTURALLY AWARE BUT WE'RE 5558 03:28:04,080 --> 03:28:05,081 CULTURALLY COMPETENT. 5559 03:28:05,081 --> 03:28:07,784 SO THAT WHEN WE HAVE THESE 5560 03:28:07,784 --> 03:28:09,486 FAMILIES, WE MAKE THEM FEEL 5561 03:28:09,486 --> 03:28:10,854 VALUED IN THE WAY THAT MATTERS 5562 03:28:10,854 --> 03:28:11,588 TO THEM. 5563 03:28:11,588 --> 03:28:13,623 AND I MEAN, WE GET PLENTY OF 5564 03:28:13,623 --> 03:28:15,358 HELP HONESTLY, YOU'VE HEARD ME 5565 03:28:15,358 --> 03:28:17,027 TALK ABOUT MY PARTNERSHIP WITH 5566 03:28:17,027 --> 03:28:18,161 THE CP FOUNDATION. 5567 03:28:18,161 --> 03:28:20,931 I'VE HAD TO LEARN A LOT ABOUT 5568 03:28:20,931 --> 03:28:24,968 WHAT DISABILITY IS BEYOND WHAT I 5569 03:28:24,968 --> 03:28:28,672 THOUGHT I COULD. 5570 03:28:28,672 --> 03:28:29,072 >> Jim: RACHEL. 5571 03:28:29,072 --> 03:28:31,041 DO YOU WANT TO CHIME IN ON THAT 5572 03:28:31,041 --> 03:28:31,374 ALSO? 5573 03:28:31,374 --> 03:28:34,311 >> YEAH, I THINK IT'S REALLY 5574 03:28:34,311 --> 03:28:35,512 IMPORTANT FROM THE STRATEGY FROM 5575 03:28:35,512 --> 03:28:37,047 THE BEGINNING AND THIS IS THE 5576 03:28:37,047 --> 03:28:38,548 PAY WHERE STAKEHOLDER 5577 03:28:38,548 --> 03:28:40,116 DEVELOPMENT AND STAKEHOLDER 5578 03:28:40,116 --> 03:28:41,284 COMMUNITY PARTICIPATION WHEN YOU 5579 03:28:41,284 --> 03:28:42,819 THINK ABOUT THE METHODOLOGY OF 5580 03:28:42,819 --> 03:28:44,087 THE STUDIES AND THINKING ABOUT 5581 03:28:44,087 --> 03:28:47,290 THE DESIGN AND IS IMPORTANT SO 5582 03:28:47,290 --> 03:28:49,793 ALL PEOPLE CAN PARTICIPATE, 5583 03:28:49,793 --> 03:28:50,227 RIGHT. 5584 03:28:50,227 --> 03:28:52,262 SOMETIMES WE CAN GET STUCK IN 5585 03:28:52,262 --> 03:28:54,498 GOING OR WE WANT TO DESIGN THE 5586 03:28:54,498 --> 03:28:56,032 PERFECT STUDY BUT THE PERFECT 5587 03:28:56,032 --> 03:28:57,801 STUDY MAY NOT BE APPLICABLE TO 5588 03:28:57,801 --> 03:29:01,304 THE COMMUNITY OR IT MAY NOT BE 5589 03:29:01,304 --> 03:29:04,040 EITHER WAY, TRANSLATABLE TO REAL 5590 03:29:04,040 --> 03:29:04,741 LIFE, RIGHT. 5591 03:29:04,741 --> 03:29:07,010 SO I THINK THESE PIECES AND 5592 03:29:07,010 --> 03:29:08,645 HAVING STAKEHOLDER INVOLVEMENT 5593 03:29:08,645 --> 03:29:10,146 NOT JUST AS ACTIVE PARTICIPANTS 5594 03:29:10,146 --> 03:29:12,582 IN THE STUDY BUT FROM THE 5595 03:29:12,582 --> 03:29:16,453 BEGINNING IS REALLY CHANGING THE 5596 03:29:16,453 --> 03:29:17,921 LANDS SCAPE AS TO HAVING SUCCESS 5597 03:29:17,921 --> 03:29:20,790 IN THESE PROJECTS. 5598 03:29:20,790 --> 03:29:21,691 >> Jim: AND SO, IN THAT 5599 03:29:21,691 --> 03:29:22,993 PARTICULAR CONTEXT, IF YOU'VE 5600 03:29:22,993 --> 03:29:25,462 GOT A SUBJECT FAMILY, A SUBJECT 5601 03:29:25,462 --> 03:29:26,863 AND THEIR FAMILY THAT'S ENGAGE 5602 03:29:26,863 --> 03:29:37,407 IN A STUDY, NATALIE, REACHEL AND 5603 03:29:40,677 --> 03:29:42,279 BERNADETTE, HOW DO YOU GET THE 5604 03:29:42,279 --> 03:29:43,680 RESEARCH BACK TO THE FAMILY AND 5605 03:29:43,680 --> 03:29:48,151 HOW DO THEY RESPOND TO THAT? 5606 03:29:48,151 --> 03:29:49,552 >> GREAT QUESTION, WE'VE LEARNED 5607 03:29:49,552 --> 03:29:50,820 A LOT AND WORKING WITH RACHEL 5608 03:29:50,820 --> 03:30:01,298 TOO AND WE TRANSLATE WE SEND 5609 03:30:05,235 --> 03:30:08,305 THEM TO THE FAMILY AND THE OTHER 5610 03:30:08,305 --> 03:30:15,345 FIRE DEPARTFIRE DEPARTPH.D, LETN 5611 03:30:15,345 --> 03:30:16,413 LANGUAGE INTERPRETATION THERE AS 5612 03:30:16,413 --> 03:30:18,548 WELL SO THAT'S ONE OF THE 5613 03:30:18,548 --> 03:30:20,216 EXAMPLES BUT HAVING THOSE 5614 03:30:20,216 --> 03:30:21,418 MEETINGS THE STAKEHOLDER 5615 03:30:21,418 --> 03:30:23,053 MEETINGS AFTER THE RESEARCH IS 5616 03:30:23,053 --> 03:30:29,826 IMPORTANT AS BEFORE THE RESEARCH 5617 03:30:29,826 --> 03:30:30,994 AND AS WELL. 5618 03:30:30,994 --> 03:30:34,164 >> THE ONE THING I LEARNED AND 5619 03:30:34,164 --> 03:30:35,799 JUST TO BE CLEAR, I DON'T 5620 03:30:35,799 --> 03:30:38,268 CONDONE THE USE OF SOCIAL MEDIA 5621 03:30:38,268 --> 03:30:40,971 AND MY CHILDREN DON'T HAVE 5622 03:30:40,971 --> 03:30:42,138 SOCIAL MEDIA HOWEVER THIS IS 5623 03:30:42,138 --> 03:30:45,875 WHERE WE NEED TO MEET OUR 5624 03:30:45,875 --> 03:30:46,910 STAKEHOLDERS AND SAME THING, I 5625 03:30:46,910 --> 03:30:49,546 GO TO RACHEL AND I'M LIKE I'M 5626 03:30:49,546 --> 03:30:50,947 Facebook ILLITERATE BUT HELP 5627 03:30:50,947 --> 03:31:00,657 ME MAKE SURE ON INSTAGRAM, ALL F 5628 03:31:00,657 --> 03:31:01,324 THESE WARES HELP ME FIND THEM 5629 03:31:01,324 --> 03:31:02,926 GET THE CHANNELS AND SHE GUIDES 5630 03:31:02,926 --> 03:31:04,594 ME AND LIKE I RECENTLY 5631 03:31:04,594 --> 03:31:07,097 DISCOVERED WHAT TO MAKE A REEL. 5632 03:31:07,097 --> 03:31:09,966 I HAD NO IDEA WHAT A REEL WAS. 5633 03:31:09,966 --> 03:31:11,701 AND YEAH Y'ALL CAN LAUGH AT ME, 5634 03:31:11,701 --> 03:31:14,938 THANK YOU, VERY MUCH BUT IT'S 5635 03:31:14,938 --> 03:31:16,940 THESE ONE-MINUTE MOVIES THAT 5636 03:31:16,940 --> 03:31:19,909 BASICALLY IN ONE MINUTE TELLING 5637 03:31:19,909 --> 03:31:21,311 YOU A NUGGET OF INFORMATION WITH 5638 03:31:21,311 --> 03:31:22,979 COOL MUSIC IN THE BACKGROUND AND 5639 03:31:22,979 --> 03:31:25,215 STUFF AND SO THIS IS, I HAD NO 5640 03:31:25,215 --> 03:31:27,817 IDEA WHAT THAT WAS. 5641 03:31:27,817 --> 03:31:28,885 THAT'S ALSO MAKING THE 5642 03:31:28,885 --> 03:31:31,521 INFORMATION IN THE FORMAT THAT 5643 03:31:31,521 --> 03:31:33,256 OUR FAMILIES WANT IT AND THEY'RE 5644 03:31:33,256 --> 03:31:34,557 LIKELY TO ACCESS IT. 5645 03:31:34,557 --> 03:31:36,226 SO I NEVER KNEW ABOUT ALL OF 5646 03:31:36,226 --> 03:31:40,630 THAT STUFF. 5647 03:31:40,630 --> 03:31:41,898 [LAUGHTER] 5648 03:31:41,898 --> 03:31:42,098 AND -- 5649 03:31:42,098 --> 03:31:45,301 >> I JUST KNOW IT'S IMPORTANT TO 5650 03:31:45,301 --> 03:31:46,836 BE COMMUNICATING WITH THESE 5651 03:31:46,836 --> 03:31:49,205 ALONG THE WHOLE RESEARCH 5652 03:31:49,205 --> 03:31:49,572 PARADIGM. 5653 03:31:49,572 --> 03:31:51,307 SO, YES AT THE BEGINNING SO EVEN 5654 03:31:51,307 --> 03:31:53,576 WHEN YOU TALK ABOUT CREATING THE 5655 03:31:53,576 --> 03:31:55,111 STUDY THAT ANNOUNCING THE STUDY 5656 03:31:55,111 --> 03:31:59,649 AND TALKING ABOUT THE RESULTS 5657 03:31:59,649 --> 03:32:01,184 AND THE PROGRESS AS IT'S GOING 5658 03:32:01,184 --> 03:32:02,519 ON, NO ONE WANTS TO KNOW WHAT 5659 03:32:02,519 --> 03:32:04,554 HAPPENS FIVE YEARS LATER, RIGHT. 5660 03:32:04,554 --> 03:32:07,023 WE WANT TO KNOW AS IT'S 5661 03:32:07,023 --> 03:32:08,525 HAPPENING AND AS MUCH AS WE CAN 5662 03:32:08,525 --> 03:32:10,060 OBVIOUSLY AND YOU CAN'T PUBLISH 5663 03:32:10,060 --> 03:32:12,095 RESULTS BEFORE YOU CAN PUBLISH 5664 03:32:12,095 --> 03:32:14,230 THEM BUT WHAT CAN YOU TELL 5665 03:32:14,230 --> 03:32:15,532 STAKEHOLDERS AND PARTICIPANTS. 5666 03:32:15,532 --> 03:32:17,667 I THINK ANOTHER PIECE IS, THIS 5667 03:32:17,667 --> 03:32:19,536 IS SOMETHING THAT I GOT TAUGHT 5668 03:32:19,536 --> 03:32:22,639 VERY AEROMEX EARLY ON, IF YOU CN 5669 03:32:22,639 --> 03:32:23,940 EXPLAIN IN PLAIN LANGUAGE, 5670 03:32:23,940 --> 03:32:25,108 DOCTORS AND RESEARCHERS CAN 5671 03:32:25,108 --> 03:32:25,809 UNDERSTAND IT AS WELL. 5672 03:32:25,809 --> 03:32:27,510 YOU DON'T HAVE TO OVERCOME NOT 5673 03:32:27,510 --> 03:32:28,878 INDICATE THINGS, WE CAN 5674 03:32:28,878 --> 03:32:30,313 ALWAYS -- YOU DON'T NEED TO HAVE 5675 03:32:30,313 --> 03:32:32,115 TWO DIFFERENT TYPES OF LANGUAGE. 5676 03:32:32,115 --> 03:32:34,317 WE CAN ACTUALLY DO THIS AND WE 5677 03:32:34,317 --> 03:32:35,952 CAN ALL TALK THE SAME AND 5678 03:32:35,952 --> 03:32:37,687 OBVIOUSLY WHAT WE'RE DOING WITH 5679 03:32:37,687 --> 03:32:39,456 DATA ELEMENTS AND WHAT WE'RE 5680 03:32:39,456 --> 03:32:40,990 TRYING TO DO WITH MEETINGS LIKE 5681 03:32:40,990 --> 03:32:43,960 THIS TODAY IS DOING THAT IN I 5682 03:32:43,960 --> 03:32:45,495 THINK THAT'S THE BIGGEST PIECE. 5683 03:32:45,495 --> 03:32:49,499 HOW CAN WE KEEP OPEN 5684 03:32:49,499 --> 03:32:50,667 COMMUNICATION CHANNELS AND MEET 5685 03:32:50,667 --> 03:32:52,102 PEOPLE WHERE THEY'RE AT WHETHER 5686 03:32:52,102 --> 03:32:54,504 IT'S ON SOCIAL MEDIA OR THAT 5687 03:32:54,504 --> 03:32:56,406 PHYSICIANS OFFICE OR COMMUNITY 5688 03:32:56,406 --> 03:32:56,806 GROUPS. 5689 03:32:56,806 --> 03:32:58,641 AND YOU KNOW, TRYING TO TELL 5690 03:32:58,641 --> 03:33:00,310 PEOPLE AS MUCH AS POSSIBLE THAT 5691 03:33:00,310 --> 03:33:01,778 HEY, THERE'S AMAZING RESEARCH 5692 03:33:01,778 --> 03:33:03,379 GOING ON BECAUSE IT'S PART OF T 5693 03:33:03,379 --> 03:33:05,215 PEOPLE DON'T KNOW WHAT THEY 5694 03:33:05,215 --> 03:33:06,015 DON'T KNOW. 5695 03:33:06,015 --> 03:33:07,150 IF WE DON'T TELL PEOPLE, THEY 5696 03:33:07,150 --> 03:33:10,086 HAVE NO IDEA THAT ANY OF THIS 5697 03:33:10,086 --> 03:33:11,154 AMAZING WORK IS HAPPENING. 5698 03:33:11,154 --> 03:33:12,355 THAT'S ONE THING THAT I WOULD 5699 03:33:12,355 --> 03:33:13,923 TELL RESEARCHERS. 5700 03:33:13,923 --> 03:33:16,159 DON'T BE SCARED TO BLAST THAT 5701 03:33:16,159 --> 03:33:19,729 FROM THE ROOF TOPS. 5702 03:33:19,729 --> 03:33:22,098 >> SORRY. 5703 03:33:22,098 --> 03:33:23,633 I WANT TO ADD THAT I THINK 5704 03:33:23,633 --> 03:33:26,035 THAT'S BEEN A REALLY EXCITING 5705 03:33:26,035 --> 03:33:28,338 AND HONESTLY VERY GRATIFYING 5706 03:33:28,338 --> 03:33:30,773 PART OF THE GENOMICS WORK IS 5707 03:33:30,773 --> 03:33:31,608 THAT, AUTOMATIC THOUGH WE'RE 5708 03:33:31,608 --> 03:33:39,849 LOOKING AT IT FROM A BIG PICTUR, 5709 03:33:39,849 --> 03:33:41,784 30,000-FOOT FEW, EACH FAMILY IS 5710 03:33:41,784 --> 03:33:43,520 A PARTICIPANT AND STAKEHOLDER IN 5711 03:33:43,520 --> 03:33:44,154 OUR STUDY. 5712 03:33:44,154 --> 03:33:45,455 SO WE HAVE THE ABILITY THROUGH 5713 03:33:45,455 --> 03:33:48,892 THE GENOMICS WORK TO RETURN 5714 03:33:48,892 --> 03:33:50,093 RESULTS DIRECTLY TO FAMILIES 5715 03:33:50,093 --> 03:33:52,195 WITH THE CAVEAT THESE ARE 5716 03:33:52,195 --> 03:33:53,263 RESEARCH FINDINGS BUT THAT 5717 03:33:53,263 --> 03:33:58,301 OFFERS A UNIQUE OPPORTUNITY TO 5718 03:33:58,301 --> 03:33:59,369 ENGAGE WITH THOSE PARTICIPANTS 5719 03:33:59,369 --> 03:33:59,702 STAKEHOLDERS. 5720 03:33:59,702 --> 03:34:03,873 >> BUT THE THING WE CAN'T 5721 03:34:03,873 --> 03:34:07,377 FORGET, WE CAN'T WAIT, YOU KNOW, 5722 03:34:07,377 --> 03:34:08,278 10 TO 17 YEARS. 5723 03:34:08,278 --> 03:34:09,612 IF WE HAVE FINDINGS WE SHOW 5724 03:34:09,612 --> 03:34:10,880 THEY'RE SAFE AND EFFECTIVE WE 5725 03:34:10,880 --> 03:34:13,116 NEED TO TRANCE LATE THEM RIGHT 5726 03:34:13,116 --> 03:34:13,316 AWAY. 5727 03:34:13,316 --> 03:34:15,618 THE REASON RACHEL AND I DECIDED 5728 03:34:15,618 --> 03:34:17,053 ON THIS CONFERENCE WHERE IT'S 5729 03:34:17,053 --> 03:34:21,424 ALL IMPLEMENTATION WORKSHOPS, IS 5730 03:34:21,424 --> 03:34:25,261 WE'VE HAD ANDY GORDAN TALK AND 5731 03:34:25,261 --> 03:34:28,431 WE'VE HAD COOL INTERVENTIONS AND 5732 03:34:28,431 --> 03:34:30,066 TO TEACH OTHER PEOPLE 5733 03:34:30,066 --> 03:34:33,136 THERAPISTS, PHYSICIANS, EVERYONE 5734 03:34:33,136 --> 03:34:34,771 IN THE COMMUNITY SO WE START 5735 03:34:34,771 --> 03:34:36,272 CHANGING THE HEALTH-CARE SYSTEM 5736 03:34:36,272 --> 03:34:38,208 NOW, NOT IN 10 OR 17 YEARS, WITH 5737 03:34:38,208 --> 03:34:40,810 THE RESULTS OF ALL THIS 5738 03:34:40,810 --> 03:34:44,480 NIH-FUNDED RESEARCH AND WHEN I 5739 03:34:44,480 --> 03:34:47,450 SAID IT HAS TO BE IMPLEMENTABLE 5740 03:34:47,450 --> 03:34:49,319 IT'S NOT JUST DISSEMINATED OR 5741 03:34:49,319 --> 03:34:50,353 KNOWLEDGE TRANSLATION BUT IT'S 5742 03:34:50,353 --> 03:34:52,021 TRUE IMPLEMENTATION AND A 5743 03:34:52,021 --> 03:34:53,723 CHANGING OF THE HEALTH-CARE 5744 03:34:53,723 --> 03:34:53,957 SYSTEM. 5745 03:34:53,957 --> 03:34:59,162 YOU KNOW, WHAT NAHAL IS DOING IS 5746 03:34:59,162 --> 03:35:00,730 AMAZING AND I HOPE PEOPLE WILL 5747 03:35:00,730 --> 03:35:02,865 CHANGE IN NEURO RADIOLOGY BASED 5748 03:35:02,865 --> 03:35:06,402 ON THAT BUT IT WON'T JUST BE A 5749 03:35:06,402 --> 03:35:11,641 RESEARCH TOOL BUT A CLINICAL 5750 03:35:11,641 --> 03:35:11,841 TOOL. 5751 03:35:11,841 --> 03:35:13,743 >> YEAH, WE'RE WORKING ON 5752 03:35:13,743 --> 03:35:14,811 TRANSLATING IT AS WELL. 5753 03:35:14,811 --> 03:35:15,545 IN DEED. 5754 03:35:15,545 --> 03:35:16,713 I TOTALLY AGREE. 5755 03:35:16,713 --> 03:35:18,948 TAKES AWAY TOO LONG TO TRANSLATE 5756 03:35:18,948 --> 03:35:20,383 RESEARCH FINDINGS TO THE 5757 03:35:20,383 --> 03:35:21,618 BEDSIDE, THAT'S WHY, ESPECIALLY 5758 03:35:21,618 --> 03:35:23,253 SOME OF US THAT ARE CLINICIANS 5759 03:35:23,253 --> 03:35:27,090 NODE TO WORK EVEN HARDER TO 5760 03:35:27,090 --> 03:35:28,791 TRANSLATE IT. 5761 03:35:28,791 --> 03:35:30,660 >> Jim: I'M SURE THAT KATHY AND 5762 03:35:30,660 --> 03:35:32,695 BHOOMA WITH THEIR ANIMAL 5763 03:35:32,695 --> 03:35:35,031 STUDIES, THE MECHANISTIC STUDIES 5764 03:35:35,031 --> 03:35:36,499 SEE A LONGER TIMELINE THERE. 5765 03:35:36,499 --> 03:35:38,534 >> SO I THINK IF I COULD JUST 5766 03:35:38,534 --> 03:35:40,536 ADD TO THAT, IT'S SO VALUABLE 5767 03:35:40,536 --> 03:35:42,005 THINKING ABOUT TRANSLATION AND 5768 03:35:42,005 --> 03:35:43,973 WHAT THE TIMELINE IS AND I THINK 5769 03:35:43,973 --> 03:35:48,444 WHAT WE'RE SEEING MORE AND MORE 5770 03:35:48,444 --> 03:35:50,780 IS THIS KIND OF AGE-OLD CONCEPT 5771 03:35:50,780 --> 03:35:52,548 OF YOU START MECHANISTIC, YOU 5772 03:35:52,548 --> 03:35:55,418 THINK ABOUT A MODEL, COME UP 5773 03:35:55,418 --> 03:35:56,386 WITH THE TARGET. 5774 03:35:56,386 --> 03:35:57,787 DEVELOP A DRUG AND TEST THE DRUG 5775 03:35:57,787 --> 03:35:59,889 FOR SAFETY AND THEN YOU TAKE TO 5776 03:35:59,889 --> 03:36:01,591 PHASE 1, PHASE 2, PHASE 3 TRIALS 5777 03:36:01,591 --> 03:36:04,427 AND IT FEELS VERY LINEAR AND 5778 03:36:04,427 --> 03:36:05,595 THAT'S HOW I LEARNED ABOUT DID 5779 03:36:05,595 --> 03:36:07,497 IN TRAINING. 5780 03:36:07,497 --> 03:36:11,100 THAT THAT'S THE 10, 15, 30 YEAR 5781 03:36:11,100 --> 03:36:11,367 LONG PATH. 5782 03:36:11,367 --> 03:36:14,203 YOU I THINK CONFERENCES LIKE 5783 03:36:14,203 --> 03:36:15,738 THIS MAKE IT CLEAR WE SHOULD ALL 5784 03:36:15,738 --> 03:36:17,307 BE IN THE SAME ROOM TOGETHER 5785 03:36:17,307 --> 03:36:19,042 FROM THE BEGINNING AND THAT 5786 03:36:19,042 --> 03:36:19,842 FAMILIES, PEOPLE WITH CEREBRAL 5787 03:36:19,842 --> 03:36:23,379 PALSY, CLINICAL RESEARCHERS, THE 5788 03:36:23,379 --> 03:36:25,882 NIH, BASIC SCIENCE RESEARCHERS, 5789 03:36:25,882 --> 03:36:27,417 AND COME TOGETHER AND TALK ABOUT 5790 03:36:27,417 --> 03:36:30,386 OUR GOALS FROM THE OUTSIDE AND 5791 03:36:30,386 --> 03:36:32,322 INFORM WHAT WE'RE DOING IN EACH 5792 03:36:32,322 --> 03:36:34,557 OTHER'S LABS FROM THE OUTSIDE. 5793 03:36:34,557 --> 03:36:36,726 AND WE TRY VERY HARD TO DO THAT 5794 03:36:36,726 --> 03:36:39,095 IN THE LAB AND IN PART SOME OF 5795 03:36:39,095 --> 03:36:40,863 THE POWER OF BEING A PHYSICIAN 5796 03:36:40,863 --> 03:36:42,265 SCIENTIST OR HAVING PHYSICIAN IN 5797 03:36:42,265 --> 03:36:43,933 SCIENCE PARTNERS TOGETHER, IS 5798 03:36:43,933 --> 03:36:46,669 WHEN YOU ASSESS SOMETHING IN A 5799 03:36:46,669 --> 03:36:48,771 MOUSE OR A RABBIT OR YOUR ANIMAL 5800 03:36:48,771 --> 03:36:51,274 MODEL YOU CAN SAY, THIS IS HOW 5801 03:36:51,274 --> 03:36:53,943 WE CAN ASSESS THIS IN THE CLINIC 5802 03:36:53,943 --> 03:36:55,378 THEREFORE, FROM THE OUTSET AND 5803 03:36:55,378 --> 03:36:57,146 THE ANIMAL MOLD IS CLINICALLY 5804 03:36:57,146 --> 03:36:58,448 RELEVANT BECAUSE YOU ARE NOT 5805 03:36:58,448 --> 03:37:00,450 LOOKING FOR WHAT YOU THINK IN MY 5806 03:37:00,450 --> 03:37:04,687 CASE, DYSTONIA IS IN A MOUSE FRM 5807 03:37:04,687 --> 03:37:09,025 THE MODEL PERSPECTIVE BUT A 5808 03:37:09,025 --> 03:37:11,694 CLINICALLY RELATIVE PERSPECTIVE. 5809 03:37:11,694 --> 03:37:14,163 I'M PROUD THAT THAT IS THE 5810 03:37:14,163 --> 03:37:15,465 STANDARD AND WE'RE ALL IN THE 5811 03:37:15,465 --> 03:37:16,232 SAME ZOOM ROOM TOGETHER. 5812 03:37:16,232 --> 03:37:17,266 I DON'T THINK IT WOULD HAVE 5813 03:37:17,266 --> 03:37:18,668 ALWAYS BEEN THAT WAY OR IT'S NOT 5814 03:37:18,668 --> 03:37:20,570 HOW I WAS TOLD IT WAS AND I KIND 5815 03:37:20,570 --> 03:37:22,338 OF STARTED MY CAREER IN THE 5816 03:37:22,338 --> 03:37:24,240 FORMAT WHICH I'M VERY GRATEFUL 5817 03:37:24,240 --> 03:37:24,407 FOR. 5818 03:37:24,407 --> 03:37:26,476 >> THIS IS ALSO WHAT FAMILIES 5819 03:37:26,476 --> 03:37:27,777 ARE LOOKING FOR. 5820 03:37:27,777 --> 03:37:29,345 THIS IS NUMBER ONE QUESTION THEY 5821 03:37:29,345 --> 03:37:32,615 HAVE FOR ME, AS A CLINICAL 5822 03:37:32,615 --> 03:37:34,117 SCIENTIST, IS SO, IS THIS GOING 5823 03:37:34,117 --> 03:37:35,551 TO BE IN THE CLINIC? 5824 03:37:35,551 --> 03:37:37,720 IS THIS ACCESSIBLE OR NOT? 5825 03:37:37,720 --> 03:37:40,890 HOW DO YOU ANSWER THAT AT THE 5826 03:37:40,890 --> 03:37:45,928 BEGINNING OF EYE STUDY? 5827 03:37:45,928 --> 03:37:47,230 YOU ARE WORKING TOGETHER IN ELSE 5828 03:37:47,230 --> 03:37:48,865 IT OF UNDERSTANDING WHAT IS 5829 03:37:48,865 --> 03:37:49,132 HAPPENING. 5830 03:37:49,132 --> 03:37:50,733 I LIKE WHAT RACHEL SAID, YOU 5831 03:37:50,733 --> 03:37:51,801 CAN'T EXPLAIN WHAT IS HAPPENED 5832 03:37:51,801 --> 03:37:53,703 ACROSS THE CONTINUUM OF AN 5833 03:37:53,703 --> 03:37:55,972 ENTIRE STUDY BUT FOR EXAMPLE, IN 5834 03:37:55,972 --> 03:37:58,241 OUR LONGITUDINAL STUDY IT'S A 5835 03:37:58,241 --> 03:37:59,275 TWO-YEAR STUDY AND THEY'RE 5836 03:37:59,275 --> 03:38:00,877 COMING UP WITH THE FIRST TWO 5837 03:38:00,877 --> 03:38:01,277 YEARS LIFE. 5838 03:38:01,277 --> 03:38:03,513 WE HAVE A TRAVEL PASSPORTS, 5839 03:38:03,513 --> 03:38:04,747 TRAVEL THROUGH THE STUDY 5840 03:38:04,747 --> 03:38:09,752 PASSPORT AND UP STAMPS IN A BOOK 5841 03:38:09,752 --> 03:38:11,254 AND SHOWS THE CHANGE OVER TIME. 5842 03:38:11,254 --> 03:38:13,489 IT'S NOT GIVING AWAY THE RESULTS 5843 03:38:13,489 --> 03:38:17,293 OF A STUDY. 5844 03:38:17,293 --> 03:38:18,861 IT'S A JOURNEY TO SAY HOW CLOSE 5845 03:38:18,861 --> 03:38:20,630 ARE WE GETTING THIS INTO THE 5846 03:38:20,630 --> 03:38:20,863 CLINIC. 5847 03:38:20,863 --> 03:38:22,031 THIS IS WHERE WORE GOING RIGHT 5848 03:38:22,031 --> 03:38:22,198 NOW. 5849 03:38:22,198 --> 03:38:23,566 IT'S REALLY IMPORTANT PIECES TO 5850 03:38:23,566 --> 03:38:26,769 INVOLVE THE STAKEHOLDERS AND I 5851 03:38:26,769 --> 03:38:28,337 COMPLETE AGREE WITH BHOOMA IN 5852 03:38:28,337 --> 03:38:29,872 TERMS THAT WE NEED TO BE IN THE 5853 03:38:29,872 --> 03:38:31,374 SAME ROOM WHETHER IT'S ZOOM ROOM 5854 03:38:31,374 --> 03:38:36,746 OR NOT SO THANK YOU NIH FOR 5855 03:38:36,746 --> 03:38:38,681 BRINGING US TOGETHER IN THIS 5856 03:38:38,681 --> 03:38:38,915 MANNER. 5857 03:38:38,915 --> 03:38:40,783 >> Jim: WELL, IT'S OUR PLEASURE. 5858 03:38:40,783 --> 03:38:42,285 SO, I'M GOING TO SAY THANK YOU 5859 03:38:42,285 --> 03:38:45,521 TO YOU ALL FOR A WONDERFUL 5860 03:38:45,521 --> 03:38:48,391 AFTERNOON AND WONDERFUL MORNING. 5861 03:38:48,391 --> 03:38:51,994 IT'S BEEN A GREAT DIALOGUE AND I 5862 03:38:51,994 --> 03:38:52,795 HOPE THAT EVERYBODY IS ENJOYED 5863 03:38:52,795 --> 03:38:53,362 IT. 5864 03:38:53,362 --> 03:38:59,368 I'M GOING TO KICK OFFER TO MY 5865 03:38:59,368 --> 03:39:03,039 COLLEAGUE SAHANA KUKKE WHO WILL 5866 03:39:03,039 --> 03:39:03,973 WRAP IT UP FOR TODAY. 5867 03:39:03,973 --> 03:39:06,709 >> THANK YOU, JIM. 5868 03:39:06,709 --> 03:39:08,010 HELLO, MY NAM IS SAHANA AND I'M 5869 03:39:08,010 --> 03:39:10,346 A PROGRAM DIRECTOR FOR NEURAL 5870 03:39:10,346 --> 03:39:13,649 ENGINEERING AND NEURO TECHNOLOGY 5871 03:39:13,649 --> 03:39:15,251 RESEARCH AT NINDS AND IN THE 5872 03:39:15,251 --> 03:39:16,118 BRAIN INITIATIVE. 5873 03:39:16,118 --> 03:39:17,320 ON BEHALF OF THE PLANNING 5874 03:39:17,320 --> 03:39:19,489 COMMITTEE FOR THE CEREBRAL PALSY 5875 03:39:19,489 --> 03:39:21,390 WORKSHOP, THANK YOU TO ALL OUR 5876 03:39:21,390 --> 03:39:23,292 SPEAKERS FOR THESE STIMULATING 5877 03:39:23,292 --> 03:39:25,294 PRESENTATIONS AND TO AWFUL YOU 5878 03:39:25,294 --> 03:39:26,696 FOR THE ROBUST DISCUSSION ON 5879 03:39:26,696 --> 03:39:30,132 BASIC AND TRANSLATIONAL RESEARCH 5880 03:39:30,132 --> 03:39:30,366 TODAY. 5881 03:39:30,366 --> 03:39:32,702 WE HEARD FROM RACHEL BYRNE OF 5882 03:39:32,702 --> 03:39:33,903 THE CEREBRAL PALSY FOUNDATION 5883 03:39:33,903 --> 03:39:35,838 WHO INTRODUCED US TO THE 5884 03:39:35,838 --> 03:39:37,840 FOUNDATION'S STAKEHOLDER-DRIVEN 5885 03:39:37,840 --> 03:39:40,009 PERSPECTIVE ON MAKING CHANGE AND 5886 03:39:40,009 --> 03:39:41,177 CEREBRAL PALSY RESEARCH 5887 03:39:41,177 --> 03:39:43,646 INFRASTRUCTURE AND 5888 03:39:43,646 --> 03:39:45,648 IMPLEMENTATION, ADVOCACY AND 5889 03:39:45,648 --> 03:39:47,350 POLICY AND DISSEMINATION AND 5890 03:39:47,350 --> 03:39:47,617 EDUCATION. 5891 03:39:47,617 --> 03:39:50,052 AND WE HAD THE PLEASURE OF 5892 03:39:50,052 --> 03:39:51,153 HEARING FROM CAYDANCE ANDERSON 5893 03:39:51,153 --> 03:39:52,755 IN THE VOICE OF THE PARTICIPANT 5894 03:39:52,755 --> 03:39:54,557 WHO GRACIOUSLY SHARED HER 5895 03:39:54,557 --> 03:39:56,559 PERSONAL EXPERIENCES AS A YOUNG 5896 03:39:56,559 --> 03:39:57,760 WOMAN PARTICIPATING IN A 5897 03:39:57,760 --> 03:39:59,128 CEREBRAL PALSY REHABILITATION 5898 03:39:59,128 --> 03:40:00,329 RESEARCH STUDY. 5899 03:40:00,329 --> 03:40:02,231 SHE VOICED HER ROW MARKETABLE 5900 03:40:02,231 --> 03:40:03,799 COMMITMENT TO EDUCATING OTHERS 5901 03:40:03,799 --> 03:40:05,301 AND ENCOURAGING CHILDREN WITH 5902 03:40:05,301 --> 03:40:06,469 CEREBRAL PALSY WHO ARE YOUNGER 5903 03:40:06,469 --> 03:40:08,771 THAN SHE IS. 5904 03:40:08,771 --> 03:40:12,074 HER REMARKS PROVIDED AN 5905 03:40:12,074 --> 03:40:13,109 ESSENTIAL REFERENCE FRAME AND 5906 03:40:13,109 --> 03:40:14,210 INSPIRATION FOR OUR DISCUSSIONS 5907 03:40:14,210 --> 03:40:19,715 ON CEREBRAL PALSY RESEARCH. 5908 03:40:19,715 --> 03:40:21,450 WOAD PRESENTATIONS COVERING A 5909 03:40:21,450 --> 03:40:24,554 BROAD AND INTEGRATED RANGE OF 5910 03:40:24,554 --> 03:40:25,354 RESEARCH. 5911 03:40:25,354 --> 03:40:28,224 DEPENDING ON THE QUESTIONS 5912 03:40:28,224 --> 03:40:29,759 QUESTIONS BEING ASKED, DIFFERENT 5913 03:40:29,759 --> 03:40:34,397 ANIMAL MODELS CAN BE USEFUL IN 5914 03:40:34,397 --> 03:40:35,865 MOUSE PUPS IN CHARACTERIZING 5915 03:40:35,865 --> 03:40:39,101 DYSTONIA AND RABBIT KITS AFTER 5916 03:40:39,101 --> 03:40:39,936 WHITE MATTER INJURY. 5917 03:40:39,936 --> 03:40:41,370 IN HUMAN STUDIES WE HEARD ABOUT 5918 03:40:41,370 --> 03:40:43,839 A RANGE OF STUDY DESIGN 5919 03:40:43,839 --> 03:40:46,442 INCLUDING THE NF1 DESIGN AND 5920 03:40:46,442 --> 03:40:47,643 GENETIC NEURO DEVELOPMENTAL 5921 03:40:47,643 --> 03:40:52,481 DISORDERS AND PARENT-CHILD DYADS 5922 03:40:52,481 --> 03:40:53,449 AND NEWBORNS AND AGE RELEVANT 5923 03:40:53,449 --> 03:40:55,351 TASKS AND STIMULATION PARADIGMS 5924 03:40:55,351 --> 03:40:57,086 AND STUDIES. 5925 03:40:57,086 --> 03:40:58,254 ALTHOUGH WE HAVE COVERED AN 5926 03:40:58,254 --> 03:41:00,056 IMPRESSIVE RANGE OF TOPICS, AND 5927 03:41:00,056 --> 03:41:01,824 BASIC TRANSLATIONAL RESEARCH, 5928 03:41:01,824 --> 03:41:03,726 THERE REMAINS SOME GAPS. 5929 03:41:03,726 --> 03:41:05,394 SOME INCLUDE THE NEED FOR 5930 03:41:05,394 --> 03:41:07,129 LEARNING COHORTS FROM DIVERSE 5931 03:41:07,129 --> 03:41:09,231 BACKGROUNDS IN GENOMIC DATABASES 5932 03:41:09,231 --> 03:41:11,133 AND MORE SENSITIVE AND ABJECT 5933 03:41:11,133 --> 03:41:13,536 TIVE TESTS FOR MILD CEREBRAL 5934 03:41:13,536 --> 03:41:13,903 PALSY. 5935 03:41:13,903 --> 03:41:15,571 AND UNDERSTANDING DOSING WHEN 5936 03:41:15,571 --> 03:41:17,206 USING NEURO MODULATION 5937 03:41:17,206 --> 03:41:18,140 STRATEGIES AND OTHERS THAT MAY 5938 03:41:18,140 --> 03:41:25,881 HAVE COME TO YOUR BLI MIND. 5939 03:41:25,881 --> 03:41:28,184 WE HOPE IT MAKES PROGRESS AND 5940 03:41:28,184 --> 03:41:29,485 THROUGH FUTURE NIH GRANT 5941 03:41:29,485 --> 03:41:31,487 APPLICATIONS TO ADDRESS THE 5942 03:41:31,487 --> 03:41:31,954 GAPS. 5943 03:41:31,954 --> 03:41:34,123 A LARGE PREPORTION OF NIH 5944 03:41:34,123 --> 03:41:35,758 RESEARCH IS FUNDED THROUGH 5945 03:41:35,758 --> 03:41:37,226 INVESTIGATORS INITIATED HAPPEN 5946 03:41:37,226 --> 03:41:38,527 INDICATIONS AND WE ENCOURAGE YOU 5947 03:41:38,527 --> 03:41:40,396 TO CONSIDER RESEARCH PROPOSALS 5948 03:41:40,396 --> 03:41:43,466 TO BETTER UNDERSTAND HOW THE 5949 03:41:43,466 --> 03:41:45,001 BRAIN RECOVERS FROM PRE-NATAL 5950 03:41:45,001 --> 03:41:47,336 INSULTS AND PROMOTE RECOVERY AND 5951 03:41:47,336 --> 03:41:48,070 CEREBRAL PALSY. 5952 03:41:48,070 --> 03:41:49,705 THE NIH PROGRAM STAFF HERE TODAY 5953 03:41:49,705 --> 03:41:51,507 ARE HAPPY TO HELP GUIDE YOU 5954 03:41:51,507 --> 03:41:53,075 THROUGH THE APPLICATION PROCESS 5955 03:41:53,075 --> 03:41:54,377 SO PLEASE DON'T HESITATE TO 5956 03:41:54,377 --> 03:41:57,246 REACH OUT TO US. 5957 03:41:57,246 --> 03:42:00,182 TOMORROW, WE WILL MEET AGAIN FOR 5958 03:42:00,182 --> 03:42:00,583 DAY 2. 5959 03:42:00,583 --> 03:42:05,354 FROM 11:00 TO 4 :00 EASTERN TIME. 5960 03:42:05,354 --> 03:42:07,156 THE MAIN TOPICS FOR TOMORROW'S 5961 03:42:07,156 --> 03:42:08,958 SESSION ARE CLINICAL RESEARCH, 5962 03:42:08,958 --> 03:42:11,060 AND WORKFORCE AND RESOURCE 5963 03:42:11,060 --> 03:42:11,360 DEVELOPMENT. 5964 03:42:11,360 --> 03:42:12,828 SO GET YOUR QUESTIONS READY FOR 5965 03:42:12,828 --> 03:42:14,630 ANOTHER GREAT DISCUSSION. 5966 03:42:14,630 --> 03:42:16,732 YOU CAN USE THE SAME ZOOM 5967 03:42:16,732 --> 03:42:18,634 WEBINAR LINK YOU USED TODAY. 5968 03:42:18,634 --> 03:42:20,136 THANK YOU AGAIN FOR YOUR 5969 03:42:20,136 --> 03:42:21,804 PARTICIPATION AND WE'LL SEE YOU 5970 03:42:21,804 --> 03:42:31,981 TOMORROW.